Provider Demographics
NPI:1740791185
Name:DEWEY, DYLAN M
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:M
Last Name:DEWEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 ANDREW JACKSON TRL
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4412
Mailing Address - Country:US
Mailing Address - Phone:850-530-8735
Mailing Address - Fax:
Practice Address - Street 1:327 ANDREW JACKSON TRL
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4412
Practice Address - Country:US
Practice Address - Phone:850-530-8735
Practice Address - Fax:850-530-8735
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer