Provider Demographics
NPI:1093963654
Name:HYDE, JEFFREY DWAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DWAYNE
Last Name:HYDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4548
Mailing Address - Country:US
Mailing Address - Phone:850-784-2477
Mailing Address - Fax:850-769-1166
Practice Address - Street 1:2250 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4548
Practice Address - Country:US
Practice Address - Phone:850-784-2477
Practice Address - Fax:850-769-1166
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist