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Individual

GREGORY BYRD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
4202 E FOWLER AVE STOP ATH100, TAMPA, FL 33620-8455
(630) 881-2527
Mailing address
18002 RICHMOND PLACE DR APT 1826, TAMPA, FL 33647-1731

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL2500
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AL2500
FL DEPARTMENT OF HEALTH
FL
Enumeration date
04/15/2019
Last updated
04/15/2019
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