Provider Demographics
NPI:1811160112
Name:BYERS, FAY ANNETTE
Entity type:Individual
Prefix:
First Name:FAY
Middle Name:ANNETTE
Last Name:BYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 LAWRENCE 1097
Mailing Address - Street 2:
Mailing Address - City:MILLER
Mailing Address - State:MO
Mailing Address - Zip Code:65707-8219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5555 LAWRENCE 1097
Practice Address - Street 2:
Practice Address - City:MILLER
Practice Address - State:MO
Practice Address - Zip Code:65707-8219
Practice Address - Country:US
Practice Address - Phone:417-466-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116135225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant