Provider Demographics
NPI:1427253962
Name:NYE, ROBERT (P T)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:NYE
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 E BARNETT RD
Mailing Address - Street 2:STE 130
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8674
Mailing Address - Country:US
Mailing Address - Phone:541-779-6146
Mailing Address - Fax:541-734-7592
Practice Address - Street 1:13785 LINDEN DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5023
Practice Address - Country:US
Practice Address - Phone:352-340-5924
Practice Address - Fax:352-340-5926
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62125225100000X
FL230232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ420ZMedicare PIN