Provider Demographics
NPI:1619414836
Name:BYERS, KRYSTAL L (PTA)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:L
Last Name:BYERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 KINGMAN LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4715
Mailing Address - Country:US
Mailing Address - Phone:608-333-7331
Mailing Address - Fax:
Practice Address - Street 1:3426 KINGMAN LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4715
Practice Address - Country:US
Practice Address - Phone:608-333-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2577-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant