Provider Demographics
NPI:1700084977
Name:BYERS, JUSTIN CODY (MSPT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CODY
Last Name:BYERS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3971
Mailing Address - Country:US
Mailing Address - Phone:210-403-2098
Mailing Address - Fax:
Practice Address - Street 1:300 E SONTERRA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3971
Practice Address - Country:US
Practice Address - Phone:210-403-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11774770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174770OtherPHYSICAL THERAPY LICENSUR