Healthcare Provider Details

I. General information

NPI: 1457659153
Provider Name (Legal Business Name): KIMBERLY BYERS LAVERY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 W I-20 SUITE 204
ARLINGTON TX
76017-1677
US

IV. Provider business mailing address

1713 ACORN DR
EULESS TX
76039-2464
US

V. Phone/Fax

Practice location:
  • Phone: 817-466-7276
  • Fax:
Mailing address:
  • Phone: 817-354-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1037018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: