Provider Demographics
NPI:1942483151
Name:BYRD, KELLY LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LEE
Last Name:BYRD
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:226 S ANDERSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-2015
Mailing Address - Country:US
Mailing Address - Phone:765-552-8460
Mailing Address - Fax:765-552-8470
Practice Address - Street 1:226 S ANDERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2015
Practice Address - Country:US
Practice Address - Phone:765-552-8460
Practice Address - Fax:765-552-8470
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05008240A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist