Provider Demographics
NPI:1104950690
Name:DYER, ROBERT J (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:DYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-1506
Mailing Address - Country:US
Mailing Address - Phone:308-784-2231
Mailing Address - Fax:308-784-3649
Practice Address - Street 1:303 E 12TH ST
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1506
Practice Address - Country:US
Practice Address - Phone:308-784-2231
Practice Address - Fax:308-784-3649
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist