Provider Demographics
NPI:1952892390
Name:DRYER, AMBUR (MAT, ATC, LAT, EMT-B)
Entity Type:Individual
Prefix:
First Name:AMBUR
Middle Name:
Last Name:DRYER
Suffix:
Gender:F
Credentials:MAT, ATC, LAT, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KILLDEER DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8620
Mailing Address - Country:US
Mailing Address - Phone:479-685-8174
Mailing Address - Fax:
Practice Address - Street 1:994 W MLK JR. BLVD.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-444-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer