MEDICARE: KERRY J DYER LAC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00011217	WA
2	171100000X	Acupuncturist	AC00002782	WA

General Provider Information

NPI Number	:	1619233988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERRY J DYER LAC PLLC

Provider Business Mailing Address
First Line	:	2508 66TH AVE NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-1505
Country	:	US
Telephone Number	:	360-350-6610
Fax Number	:	360-299-5177

Provider Business Practice Location Address
First Line	:	221 KENYON ST NW STE 103
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4581
Country	:	US
Telephone Number	:	360-350-6610
Fax Number	:	360-299-5177

Authorized Official
Title or Position	:	MANAGER
Name	:	KERRY J DYER
Credential	:	LAC, LMT
Telephone Number	:	360-350-6610

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	02/21/2026

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