Provider Demographics
NPI:1730503897
Name:BYRD, VARRICK (MMP, LMBT)
Entity type:Individual
Prefix:
First Name:VARRICK
Middle Name:
Last Name:BYRD
Suffix:
Gender:M
Credentials:MMP, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 LARKIN ST.
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1472
Mailing Address - Country:US
Mailing Address - Phone:336-303-1219
Mailing Address - Fax:
Practice Address - Street 1:4624 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1232
Practice Address - Country:US
Practice Address - Phone:336-303-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist