Provider Demographics
NPI:1861980237
Name:BYRNES, JARRET S (ATC)
Entity type:Individual
Prefix:
First Name:JARRET
Middle Name:S
Last Name:BYRNES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 HUGHITT AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-7231
Mailing Address - Country:US
Mailing Address - Phone:218-464-7027
Mailing Address - Fax:
Practice Address - Street 1:5615 HUGHITT AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-7231
Practice Address - Country:US
Practice Address - Phone:218-464-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer