1366619181 NPI number — MS. ADRIENNE MICHELE DYER-MCKIMMEY L.M.T.

Table of content: MS. ADRIENNE MICHELE DYER-MCKIMMEY L.M.T. (NPI 1366619181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366619181 NPI number — MS. ADRIENNE MICHELE DYER-MCKIMMEY L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYER-MCKIMMEY
Provider First Name:
ADRIENNE
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DYER
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366619181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 S 16TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18102-4519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-891-0568
Provider Business Mailing Address Fax Number:
484-891-0568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 S 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-632-5827
Provider Business Practice Location Address Fax Number:
973-632-5827
Provider Enumeration Date:
05/12/2008

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: 225700000X , with the licence number:  018623-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: MSG003217 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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