Provider Demographics
NPI:1154713501
Name:BYERS, DUSTIN ANDREW
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ANDREW
Last Name:BYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 HOLLY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-5343
Mailing Address - Country:US
Mailing Address - Phone:828-302-1897
Mailing Address - Fax:
Practice Address - Street 1:3155 AVENUE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:828-302-1897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013649225100000X
NCP15435225100000X
MTPTP-PT-LIC-9394225100000X
AZLIC-30420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist