Healthcare Provider Details

I. General information

NPI: 1114835923
Provider Name (Legal Business Name): ROBERT BYARS II PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 ATLANTIC BLVD STE 11
NEPTUNE BEACH FL
32266-4003
US

IV. Provider business mailing address

655 S WILLOW ST STE 128
MANCHESTER NH
03103-5723
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-2358
  • Fax:
Mailing address:
  • Phone: 180-099-5267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA24574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: