Provider Demographics
NPI:1245556620
Name:BYRD-RIDER, KIMBERLY K (MSPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:BYRD-RIDER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6244
Mailing Address - Country:US
Mailing Address - Phone:970-306-1163
Mailing Address - Fax:
Practice Address - Street 1:2150 HOLLOW BROOK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8413
Practice Address - Country:US
Practice Address - Phone:719-599-5330
Practice Address - Fax:719-599-5438
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist