Provider Demographics
NPI:1457365967
Name:DYER, JENNIFER L (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:DYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEA
Other - Last Name:KNOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103
Mailing Address - Country:US
Mailing Address - Phone:308-534-0999
Mailing Address - Fax:308-534-7299
Practice Address - Street 1:120 WEST LEOTA STREET
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6036
Practice Address - Country:US
Practice Address - Phone:308-534-0999
Practice Address - Fax:308-534-7299
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00166238OtherPALMETTO GBA RR MEDICARE
NE39956OtherBLUE CROSS BLUE SHIELD
NE47084123332Medicaid
277794Medicare ID - Type Unspecified