Provider Demographics
NPI:1023121886
Name:BYERS, MATHEW SHERRED (RPT)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:SHERRED
Last Name:BYERS
Suffix:
Gender:M
Credentials:RPT
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 487
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-0487
Mailing Address - Country:US
Mailing Address - Phone:808-934-7651
Mailing Address - Fax:808-935-6895
Practice Address - Street 1:333 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3013
Practice Address - Country:US
Practice Address - Phone:808-961-3505
Practice Address - Fax:808-961-6505
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49905503Medicaid
HI49905503Medicaid