Provider Demographics
NPI:1225873391
Name:BYRD, KATHRYN F (LMT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:F
Last Name:BYRD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 NAVAJO TRL
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-3114
Mailing Address - Country:US
Mailing Address - Phone:636-384-6308
Mailing Address - Fax:
Practice Address - Street 1:100 W 2ND ST N STE D
Practice Address - Street 2:
Practice Address - City:WRIGHT CITY
Practice Address - State:MO
Practice Address - Zip Code:63390-1042
Practice Address - Country:US
Practice Address - Phone:636-384-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023041365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist