MEDICARE: MR. JUSTIN CODY BYERS MSPT

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
1	225100000X	Physical Therapist	11774770	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174770	OTHER	TX	PHYSICAL THERAPY LICENSUR

General Provider Information

NPI Number	:	1700084977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN CODY BYERS MSPT

Provider Business Mailing Address
First Line	:	300 E SONTERRA BLVD
Second Line	:	SUITE 210
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3971
Country	:	US
Telephone Number	:	210-403-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E SONTERRA BLVD
Second Line	:	SUITE 210
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3971
Country	:	US
Telephone Number	:	210-403-2098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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