Provider Demographics
NPI:1528567724
Name:DYER, ANTOINETTE M (LMT)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:M
Last Name:DYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:M
Other - Last Name:JOHNSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1907
Mailing Address - Country:US
Mailing Address - Phone:864-363-5382
Mailing Address - Fax:
Practice Address - Street 1:122 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1517
Practice Address - Country:US
Practice Address - Phone:864-363-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist