=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891218533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BYRD ASSISTIVE TECHNOLOGIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2017
-----------------------------------------------------
Last Update Date | 05/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13893 WILLARD RD STE A
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-252-5214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13893 WILLARD RD STE A
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DUNCAN BYRD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-252-5214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 17-BYRD
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------