Provider Demographics
NPI:1053377721
Name:LONG, BYRON LOUIS (MPT)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:LOUIS
Last Name:LONG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BLUEGRASS CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7323
Mailing Address - Country:US
Mailing Address - Phone:307-634-2626
Mailing Address - Fax:307-634-5099
Practice Address - Street 1:1950 BLUEGRASS CIR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7323
Practice Address - Country:US
Practice Address - Phone:307-634-2626
Practice Address - Fax:307-634-5099
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007408225100000X
WY1231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist