Provider Demographics
NPI:1932400314
Name:DYRESON, JENNIFER A (PT, MPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:DYRESON
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:HOUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4407 N. DIVISION ST. FORTE THERAPY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1613
Mailing Address - Country:US
Mailing Address - Phone:509-474-9197
Mailing Address - Fax:509-443-3834
Practice Address - Street 1:4407 N. DIVISION ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1613
Practice Address - Country:US
Practice Address - Phone:509-474-9197
Practice Address - Fax:509-443-3834
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0008752225100000X
WAPT00008752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0410754OtherLABOR-INDUSTRIES