Provider Demographics
NPI:1487946927
Name:BYRD, JENISHA GABRIELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:JENISHA
Middle Name:GABRIELLE
Last Name:BYRD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JENISHA
Other - Middle Name:GABRIELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:14730 4TH ST APT 235
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14730 4TH ST APT 235
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3725
Practice Address - Country:US
Practice Address - Phone:469-693-5259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist