Provider Demographics
NPI:1033594213
Name:NADEAN DYER'S PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:NADEAN DYER'S PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-217-0267
Mailing Address - Street 1:1765 BROOKSFALL CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3506
Mailing Address - Country:US
Mailing Address - Phone:805-217-0267
Mailing Address - Fax:
Practice Address - Street 1:1765 BROOKSFALL CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3506
Practice Address - Country:US
Practice Address - Phone:805-217-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375038174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty