Provider Demographics
NPI:1912125931
Name:NYBERG, PATRICIA FAYE (LMT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:FAYE
Last Name:NYBERG
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:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-0983
Mailing Address - Country:US
Mailing Address - Phone:352-226-2976
Mailing Address - Fax:352-472-4365
Practice Address - Street 1:25355 W. NEWBERRY RD.
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669
Practice Address - Country:US
Practice Address - Phone:352-226-2976
Practice Address - Fax:352-472-4365
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3950OtherBCBS PROVIDER NUMBER