Provider Demographics
NPI:1124352208
Name:MILLWOOD, BYRON (MS, ATC, SCAT)
Entity type:Individual
Prefix:MR
First Name:BYRON
Middle Name:
Last Name:MILLWOOD
Suffix:
Gender:M
Credentials:MS, ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-8718
Mailing Address - Country:US
Mailing Address - Phone:864-490-0207
Mailing Address - Fax:803-821-1938
Practice Address - Street 1:840 MAIN ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-8443
Practice Address - Country:US
Practice Address - Phone:803-821-1985
Practice Address - Fax:803-821-1938
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer