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NPI Code Detail

MEDICARE: KELLY M BYRNES DPT

MEDICARE: KELLY M BYRNES DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070.020223IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070.020223OTHERILLICENSE

General Provider Information

NPI Number : 1225462955
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY M BYRNES DPT
Provider Business Mailing Address
First Line : 55 SHUMAN BLVD STE 700
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-8422
Country : US
Telephone Number : 877-632-6637
Fax Number : 708-409-5179
Provider Business Practice Location Address
First Line : 55 SHUMAN BLVD STE 700
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-8422
Country : US
Telephone Number : 877-632-6637
Fax Number : 708-409-5179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2013
Last Update Date : 12/30/2024

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