Provider Demographics
NPI:1013950468
Name:BYRD, BRIAN THOMAS (DPT, MTC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:BYRD
Suffix:
Gender:M
Credentials:DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:5010 SPEDALE CT
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6105
Practice Address - Country:US
Practice Address - Phone:931-486-0599
Practice Address - Fax:931-486-3962
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19778225100000X
TN13262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicaid
FLY006ZOtherBCBS INDIV PROV NUM
FL6698515OtherGHI INDIV PROV NUM
FL113133Medicaid
FL888024700Medicaid
FL6698515OtherGHI INDIV PROV NUM