Provider Demographics
NPI:1629471362
Name:DYBA, JENNIFER CHRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:DYBA
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 1:6034 HEATH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4352
Mailing Address - Country:US
Mailing Address - Phone:704-577-9937
Mailing Address - Fax:980-236-8077
Practice Address - Street 1:6034 HEATH VALLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4352
Practice Address - Country:US
Practice Address - Phone:704-577-9937
Practice Address - Fax:980-236-8077
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15200225100000X, 225100000X
SC7531225100000X
TX12498862251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist