Provider Demographics
NPI:1356805774
Name:BYRD RIDERS HEALTHCARE INC
Entity type:Organization
Organization Name:BYRD RIDERS HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BYRD RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-306-1163
Mailing Address - Street 1:5210 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4302
Mailing Address - Country:US
Mailing Address - Phone:305-731-0513
Mailing Address - Fax:305-294-7335
Practice Address - Street 1:37 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6244
Practice Address - Country:US
Practice Address - Phone:970-306-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy