Provider Demographics
NPI:1952462004
Name:DYER, AMY (PT)
Entity Type:Individual
Prefix:
First Name:AMY
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 1:1103 VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862
Mailing Address - Country:US
Mailing Address - Phone:865-908-3261
Mailing Address - Fax:865-908-7043
Practice Address - Street 1:11618 CHAPMAN HWY
Practice Address - Street 2:SUITE C
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-3910
Practice Address - Country:US
Practice Address - Phone:865-579-3322
Practice Address - Fax:865-579-0820
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3658480Medicare ID - Type Unspecified