Provider Demographics
NPI:1568750743
Name:DYER, ROBIN JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:JANE
Last Name:DYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 FERGUSON DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3512
Mailing Address - Country:US
Mailing Address - Phone:501-315-0639
Mailing Address - Fax:501-315-7278
Practice Address - Street 1:1115 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3512
Practice Address - Country:US
Practice Address - Phone:501-315-0639
Practice Address - Fax:501-315-7278
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist