Provider Demographics
NPI:1932400314
Name:DYRESON, JENNIFER (PT, MPT, OWNER)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DYRESON
Suffix:
Gender:F
Credentials:PT, MPT, OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7407 N DIVISION
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5689
Mailing Address - Country:US
Mailing Address - Phone:509-474-9197
Mailing Address - Fax:509-443-3834
Practice Address - Street 1:7407 N DIVISION
Practice Address - Street 2:SUITE C
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5689
Practice Address - Country:US
Practice Address - Phone:509-474-9197
Practice Address - Fax:509-443-3834
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0008752225100000X
WAPT00008752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist