Healthcare Provider Details

I. General information

NPI: 1225873391
Provider Name (Legal Business Name): KATHRYN F BYRD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 2ND ST N STE D
WRIGHT CITY MO
63390-1042
US

IV. Provider business mailing address

868 NAVAJO TRL
WARRENTON MO
63383-3114
US

V. Phone/Fax

Practice location:
  • Phone: 636-384-6308
  • Fax:
Mailing address:
  • Phone: 636-384-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2023041365
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: