Provider Demographics
NPI:1972119238
Name:SALYERS, PHOEBE RAE
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:RAE
Last Name:SALYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 EUREKA DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR MILL
Mailing Address - State:KY
Mailing Address - Zip Code:41015-2107
Mailing Address - Country:US
Mailing Address - Phone:937-218-4836
Mailing Address - Fax:
Practice Address - Street 1:5219 EUREKA DR
Practice Address - Street 2:
Practice Address - City:TAYLOR MILL
Practice Address - State:KY
Practice Address - Zip Code:41015-2107
Practice Address - Country:US
Practice Address - Phone:937-218-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY241258225700000X
OH33.019387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist