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General NPI Number Information
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NPI Number | 1548245236
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Entity Type | Individual
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Provider Name | PAUL M DYE MPT, MOTR/L, ATC,
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 36 WINN DRIVE SUITE #100
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-356-0174
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Fax | 208-356-0176
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Provider Business Mailing Address
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Address Line | 36 WINN DRIVE SUITE #100
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-356-0174
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Fax | 208-356-0176
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1920
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 711
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-1920
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-142
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-711
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License Number State | ID
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