Provider Demographics
NPI:1093939381
Name:DYER, JEFFREY N (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:N
Last Name:DYER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 SKYLINE DRIVE
Mailing Address - Street 2:100
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301
Mailing Address - Country:US
Mailing Address - Phone:731-427-7888
Mailing Address - Fax:731-265-4152
Practice Address - Street 1:569 SKYLINE DRIVE
Practice Address - Street 2:100
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-427-7888
Practice Address - Fax:731-265-4152
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000004655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3646500Medicaid
TN3646500Medicare ID - Type Unspecified