Provider Demographics
NPI:1891958286
Name:BYRD, TIVELL (MPT)
Entity Type:Individual
Prefix:MR
First Name:TIVELL
Middle Name:
Last Name:BYRD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14435 CHERRY LANE CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4959
Mailing Address - Country:US
Mailing Address - Phone:301-776-3665
Mailing Address - Fax:301-776-6669
Practice Address - Street 1:14435 CHERRY LANE CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4959
Practice Address - Country:US
Practice Address - Phone:301-776-3665
Practice Address - Fax:301-776-6669
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist