Provider Demographics
NPI:1811451313
Name:ABSHIRE, DYLAN MARK (DPT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:MARK
Last Name:ABSHIRE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S WYNNOAK CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-5715
Mailing Address - Country:US
Mailing Address - Phone:443-876-6739
Mailing Address - Fax:
Practice Address - Street 1:35 S WYNNOAK CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-5715
Practice Address - Country:US
Practice Address - Phone:443-876-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30478225100000X
MD27152225100000X
TX13297842251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist