Provider Demographics
NPI:1538295662
Name:DYER, ROBERT (LMP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1586
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-1586
Mailing Address - Country:US
Mailing Address - Phone:206-601-6783
Mailing Address - Fax:206-577-4533
Practice Address - Street 1:19217 36TH AVE W
Practice Address - Street 2:SUITE 204
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5751
Practice Address - Country:US
Practice Address - Phone:206-601-6783
Practice Address - Fax:206-577-4533
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist