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NPI Code Detail

MEDICARE: MR. BYRON TODD CRITCHFIELD P.T.

MEDICARE: MR. BYRON TODD CRITCHFIELD P.T.
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 Therapist104230MO

General Provider Information

NPI Number : 1396727467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BYRON TODD CRITCHFIELD P.T.
Provider Business Mailing Address
First Line : 4108 BIG SUR BLVD
Second Line :
City : COLUMBIA
State : MO
Zip : 65203-6704
Country : US
Telephone Number : 573-446-0524
Fax Number :
Provider Business Practice Location Address
First Line : 520 N STURGEON ST
Second Line :
City : MONTGOMERY CITY
State : MO
Zip : 63361-1829
Country : US
Telephone Number : 573-564-5222
Fax Number : 573-564-8241
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 07/08/2007

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