Provider Demographics
NPI:1386631307
Name:BYRNE, NANCY O (PT)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:O
Last Name:BYRNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:CAROUSEL PHYSICAL THERAPY
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0128
Mailing Address - Country:US
Mailing Address - Phone:804-435-3435
Mailing Address - Fax:804-435-3682
Practice Address - Street 1:500 IRVINGTON RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-9590
Practice Address - Country:US
Practice Address - Phone:804-435-3435
Practice Address - Fax:804-435-3682
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA20091OtherSENTARA
VA250404OtherBCBS PROVIDER ID
VA250404OtherBCBS PROVIDER ID