Provider Demographics
NPI:1215130364
Name:BYRON, CASEY J (MPT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:BYRON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 XERXES AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2447
Mailing Address - Country:US
Mailing Address - Phone:612-929-2513
Mailing Address - Fax:
Practice Address - Street 1:5242 XERXES AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2447
Practice Address - Country:US
Practice Address - Phone:612-929-2513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7327OtherPHYSICAL THERAPY LICENSE