Provider Demographics
NPI:1962972364
Name:STUTTS, BYRON ANTHONY (PT)
Entity type:Individual
Prefix:MR
First Name:BYRON
Middle Name:ANTHONY
Last Name:STUTTS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SONADA LN
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-9667
Mailing Address - Country:US
Mailing Address - Phone:601-606-9788
Mailing Address - Fax:662-842-7915
Practice Address - Street 1:90A CLARK ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4812
Practice Address - Country:US
Practice Address - Phone:662-840-0535
Practice Address - Fax:662-842-7915
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1522208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation