1356677397 NPI number — ROBERT DYER

Table of content: ROBERT DYER (NPI 1356677397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356677397 NPI number — ROBERT DYER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYER
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356677397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6315 NORTH CENTER DRIVE, SUITE 250
Provider Second Line Business Mailing Address:
PHYSIOPTHERAPY ASSOCIATES
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-893-9210
Provider Business Mailing Address Fax Number:
757-893-9247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6315 NORTH CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-893-9210
Provider Business Practice Location Address Fax Number:
757-893-9247
Provider Enumeration Date:
10/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305003851 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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