Provider Demographics
NPI:1740772557
Name:BYRNE, JOHN PATRICK (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:BYRNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EAST DR
Mailing Address - Street 2:
Mailing Address - City:PLANDOME
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1106
Mailing Address - Country:US
Mailing Address - Phone:516-859-6389
Mailing Address - Fax:516-365-8650
Practice Address - Street 1:17 EAST DR
Practice Address - Street 2:
Practice Address - City:PLANDOME
Practice Address - State:NY
Practice Address - Zip Code:11030-1106
Practice Address - Country:US
Practice Address - Phone:516-365-8650
Practice Address - Fax:516-365-8650
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003849-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003849-1OtherLICENSE NUMBER