Provider Demographics
NPI:1609926989
Name:BYRD, ROBERT III (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BYRD
Suffix:III
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 MIDHURST RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2527
Mailing Address - Country:US
Mailing Address - Phone:630-660-8247
Mailing Address - Fax:
Practice Address - Street 1:1501 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-3630
Practice Address - Country:US
Practice Address - Phone:847-491-5421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960014712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer