Provider Demographics
NPI:1457307159
Name:DYER, BOYD (PT)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:
Last Name:DYER
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 1:6 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4514
Mailing Address - Country:US
Mailing Address - Phone:631-697-9578
Mailing Address - Fax:516-530-1943
Practice Address - Street 1:6 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTN STA
Practice Address - State:NY
Practice Address - Zip Code:11746-4514
Practice Address - Country:US
Practice Address - Phone:631-697-9578
Practice Address - Fax:165-301-9435
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist