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NPI Code Detail

MEDICARE: MR. KENNETH E. BYRD PT

MEDICARE: MR. KENNETH E. BYRD PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT23001FL

General Provider Information

NPI Number : 1083792915
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH E. BYRD PT
Provider Business Mailing Address
First Line : 1153 GULF BREEZE PKWY
Second Line :
City : GULF BREEZE
State : FL
Zip : 32561-4835
Country : US
Telephone Number : 850-932-9223
Fax Number : 850-932-9215
Provider Business Practice Location Address
First Line : 5855 CREEK STATION DR
Second Line :
City : PENSACOLA
State : FL
Zip : 32504-8626
Country : US
Telephone Number : 850-477-4966
Fax Number : 850-477-0267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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