Provider Demographics
NPI:1730237918
Name:BYERLY PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:BYERLY PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:BYERLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-826-9426
Mailing Address - Street 1:PO BOX 4427
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-4427
Mailing Address - Country:US
Mailing Address - Phone:509-826-9426
Mailing Address - Fax:509-826-9426
Practice Address - Street 1:509 LOCUST ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9383
Practice Address - Country:US
Practice Address - Phone:509-826-9426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5488BYOtherASURIS
WA7137995Medicaid
WA0189690OtherLABOR & INDUSTRY PHYSICAL
WA7545841OtherAETNA