Provider Demographics
NPI:1760616627
Name:BYRD, MIRIAM Q (PT)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:Q
Last Name:BYRD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N DONAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-6516
Mailing Address - Country:US
Mailing Address - Phone:803-736-8350
Mailing Address - Fax:
Practice Address - Street 1:1001 WILDEWOOD DOWNS CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4434
Practice Address - Country:US
Practice Address - Phone:803-419-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist