Provider Demographics
NPI:1366723686
Name:DYER, REBECCA HEIDI (LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HEIDI
Last Name:DYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 EDMUND RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-5905
Mailing Address - Country:US
Mailing Address - Phone:781-929-4041
Mailing Address - Fax:
Practice Address - Street 1:7 NEW DRIFTWAY STE 5
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4534
Practice Address - Country:US
Practice Address - Phone:781-929-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2404172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist