Provider Demographics
NPI:1003868001
Name:DYER, JODI (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CRYSTAL PT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-6642
Mailing Address - Country:US
Mailing Address - Phone:910-423-5550
Mailing Address - Fax:910-423-5552
Practice Address - Street 1:10040 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5499
Practice Address - Country:US
Practice Address - Phone:910-818-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FL38215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC187071OtherMEDCOST
NC079YFOtherBLUE CROSS BLUE SHIELD NC
NC125357800OtherUS DEPART OF LABOR
NC501889202OtherTRICARE