Provider Demographics
NPI:1326387911
Name:DEWEY, THYRA KRISTIN (PTA)
Entity Type:Individual
Prefix:
First Name:THYRA
Middle Name:KRISTIN
Last Name:DEWEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 ELMHURST CIR
Mailing Address - Street 2:#109
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4106
Mailing Address - Country:US
Mailing Address - Phone:978-273-2971
Mailing Address - Fax:
Practice Address - Street 1:5619 ELMHURST CIR
Practice Address - Street 2:#109
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4106
Practice Address - Country:US
Practice Address - Phone:978-273-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23819225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant