Provider Demographics
NPI:1053563742
Name:BYRD, LEAH M (COF, CMF, CFTS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:BYRD
Suffix:
Gender:F
Credentials:COF, CMF, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 N CEDAR ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3926
Mailing Address - Country:US
Mailing Address - Phone:910-671-5626
Mailing Address - Fax:910-671-5616
Practice Address - Street 1:2002 N CEDAR ST
Practice Address - Street 2:SUITE A
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3926
Practice Address - Country:US
Practice Address - Phone:910-671-5626
Practice Address - Fax:910-671-5616
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C18651225000000X, 224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795474Medicaid