Provider Demographics
NPI:1912938614
Name:BYRD, SCOTT P (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:P
Last Name:BYRD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3339 HENDERSON WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9719
Mailing Address - Country:US
Mailing Address - Phone:541-776-2035
Mailing Address - Fax:541-776-2036
Practice Address - Street 1:1060 CRATER LAKE AVE
Practice Address - Street 2:STE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-2205
Practice Address - Country:US
Practice Address - Phone:541-776-2035
Practice Address - Fax:541-776-2036
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR33042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227065Medicaid
OR227065Medicaid