Provider Demographics
NPI:1588246672
Name:BYRUM, CAROLYN ME'CHELLE (AAS/PTA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ME'CHELLE
Last Name:BYRUM
Suffix:
Gender:F
Credentials:AAS/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HEARTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7470
Mailing Address - Country:US
Mailing Address - Phone:803-609-6153
Mailing Address - Fax:
Practice Address - Street 1:731 POLO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4462
Practice Address - Country:US
Practice Address - Phone:803-630-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4580225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant