Provider Demographics
NPI:1669611166
Name:BYRD, JENNIFER L (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BYRD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 MAIN ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9296
Mailing Address - Country:US
Mailing Address - Phone:423-238-5775
Mailing Address - Fax:423-238-5774
Practice Address - Street 1:5906 MAIN ST
Practice Address - Street 2:SUITE 132
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9296
Practice Address - Country:US
Practice Address - Phone:423-238-5775
Practice Address - Fax:423-238-5774
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-07
Last Update Date:2025-01-28
Deactivation Date:2024-12-09
Deactivation Code:
Reactivation Date:2025-01-28
Provider Licenses
StateLicense IDTaxonomies
TN0000003474225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist