Provider Demographics
NPI:1407151525
Name:DYER, ADAM LAWRENCE (LMT)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:LAWRENCE
Last Name:DYER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 NE 20TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3802
Mailing Address - Country:US
Mailing Address - Phone:503-453-3613
Mailing Address - Fax:
Practice Address - Street 1:519 NW 60TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6028
Practice Address - Country:US
Practice Address - Phone:503-453-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 61119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist