Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A5171 | NC |
NPI | 1013388826 |
---|---|
Provider Name | Timothy Byers |
First Address | Fuquay Varina, NC 27526-4405 |
Second Address | Sanford, NC 27330-6953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2015 |
Last Update Date | 20/10/2015 |