Provider Demographics
NPI:1497301121
Name:DYER, EMILY ANN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:DYER
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 1:4948 NOTTINGHAM PLACE LN APT 202
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4895
Mailing Address - Country:US
Mailing Address - Phone:336-907-6812
Mailing Address - Fax:
Practice Address - Street 1:246 MOUNTAIN SHADOWS DR
Practice Address - Street 2:
Practice Address - City:PURLEAR
Practice Address - State:NC
Practice Address - Zip Code:28665-9400
Practice Address - Country:US
Practice Address - Phone:336-907-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-48902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer