Provider Demographics
NPI:1336173459
Name:DYER, JOHN KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KEVIN
Last Name:DYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 RIO LINDO AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-896-1216
Mailing Address - Fax:530-896-1070
Practice Address - Street 1:670 RIO LINDO AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-896-1216
Practice Address - Fax:530-896-1070
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1966182OtherUNITED HEALTH CARE
CAPT0101980Medicaid
1966182OtherUNITED HEALTH CARE