Provider Demographics
NPI:1336731769
Name:BYERLY, MADISON KAYE (PTA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KAYE
Last Name:BYERLY
Suffix:
Gender:F
Credentials:PTA
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 3675
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-3675
Mailing Address - Country:US
Mailing Address - Phone:405-214-0300
Mailing Address - Fax:
Practice Address - Street 1:2309 N MILT PHILLIPS AVE STE B
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2328
Practice Address - Country:US
Practice Address - Phone:405-214-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3318225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant