Healthcare Provider Details

I. General information

NPI: 1548067713
Provider Name (Legal Business Name): ROBERT WILLIAM BYRNE PT, DPT, ATC/LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S 500 W
SALT LAKE CITY UT
84115-5149
US

IV. Provider business mailing address

1420 S 500 W
SALT LAKE CITY UT
84115-5149
US

V. Phone/Fax

Practice location:
  • Phone: 801-325-2716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054064
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300791
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14293238-2401
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number004947
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number14293238-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: