Provider Demographics
NPI:1568176733
Name:DYER, AMY CHAMPAGNE (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHAMPAGNE
Last Name:DYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6226
Mailing Address - Country:US
Mailing Address - Phone:207-873-5503
Mailing Address - Fax:207-877-0920
Practice Address - Street 1:234 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6226
Practice Address - Country:US
Practice Address - Phone:207-873-5503
Practice Address - Fax:207-877-0920
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist