Provider Demographics
NPI:1932642089
Name:BYERLY, LYNDA MARLENE (PT)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:MARLENE
Last Name:BYERLY
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:POB 561
Mailing Address - Street 2:27 DUFFY RD
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855
Mailing Address - Country:US
Mailing Address - Phone:509-486-2704
Mailing Address - Fax:509-826-9426
Practice Address - Street 1:509 LOCUST ST
Practice Address - Street 2:POB 4427
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9383
Practice Address - Country:US
Practice Address - Phone:509-826-9426
Practice Address - Fax:509-826-9426
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2018-02-06
Deactivation Date:2017-06-06
Deactivation Code:
Reactivation Date:2018-02-06
Provider Licenses
StateLicense IDTaxonomies
WAPT00003705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist