Provider Demographics
NPI:1962687657
Name:DWYER, RODNEY J (LMP)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:J
Last Name:DWYER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 NE FERN ST
Mailing Address - Street 2:
Mailing Address - City:SUQUAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98392-9734
Mailing Address - Country:US
Mailing Address - Phone:360-286-7782
Mailing Address - Fax:
Practice Address - Street 1:6715 NE FERN ST
Practice Address - Street 2:
Practice Address - City:SUQUAMISH
Practice Address - State:WA
Practice Address - Zip Code:98392-9734
Practice Address - Country:US
Practice Address - Phone:360-286-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025171225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist