Healthcare Provider Details

I. General information

NPI: 1760090369
Provider Name (Legal Business Name): KRISTIAN LUKE DYRLI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PLAZA CT
EAST STROUDSBURG PA
18301-8263
US

IV. Provider business mailing address

PO BOX 14123
BELFAST ME
04915-4032
US

V. Phone/Fax

Practice location:
  • Phone: 570-421-7020
  • Fax: 570-421-7091
Mailing address:
  • Phone: 570-421-7020
  • Fax: 570-421-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT028346
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: