Provider Demographics
NPI:1386424943
Name:HARVEY, DYLAN (LMT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 AVON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7503
Mailing Address - Country:US
Mailing Address - Phone:207-745-3550
Mailing Address - Fax:
Practice Address - Street 1:465 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6738
Practice Address - Country:US
Practice Address - Phone:207-745-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELMT6373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist