Provider Demographics
NPI:1720418304
Name:FLOYD, BARRY
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:FLOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11506 NICHOLAS ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4421
Mailing Address - Country:US
Mailing Address - Phone:877-230-3885
Mailing Address - Fax:
Practice Address - Street 1:11506 NICHOLAS ST STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4421
Practice Address - Country:US
Practice Address - Phone:877-230-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20841235Z00000X
SC4951235Z00000X
OR015087235Z00000X
VA2202007029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist