Provider Demographics
NPI:1659672343
Name:DYER, JESSICA (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
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 1:395 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:ME
Mailing Address - Zip Code:04910-6016
Mailing Address - Country:US
Mailing Address - Phone:813-263-4431
Mailing Address - Fax:
Practice Address - Street 1:395 CLARK RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:ME
Practice Address - Zip Code:04910-6016
Practice Address - Country:US
Practice Address - Phone:813-263-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3740225100000X
FLPT22213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist