Provider Demographics
NPI:1447730858
Name:BYRD, TOREY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TOREY
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-4448
Mailing Address - Country:US
Mailing Address - Phone:618-530-6273
Mailing Address - Fax:
Practice Address - Street 1:1150 COLUMBIA CTR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2559
Practice Address - Country:US
Practice Address - Phone:618-281-6681
Practice Address - Fax:618-281-6691
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist