Provider Demographics
NPI:1780616060
Name:BYRD, THOMAS M (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:BYRD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3167
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3167
Mailing Address - Country:US
Mailing Address - Phone:318-323-6405
Mailing Address - Fax:318-410-8290
Practice Address - Street 1:210 LAYTON AVE STE 20
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8548
Practice Address - Country:US
Practice Address - Phone:318-323-6405
Practice Address - Fax:318-410-8290
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA01634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist