Provider Demographics
NPI:1902004609
Name:AMES, BYRON E (PT)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:E
Last Name:AMES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:AMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:660 E EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4252
Mailing Address - Country:US
Mailing Address - Phone:321-773-5290
Mailing Address - Fax:321-773-5268
Practice Address - Street 1:4270 MINTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9578
Practice Address - Country:US
Practice Address - Phone:321-690-6612
Practice Address - Fax:321-690-2630
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 2171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT2171OtherPT LICENSE