MEDICARE: MR. KRISTY DANIELLE DYER PT

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	225100000X	Physical Therapist	002054	KY

General Provider Information

NPI Number	:	1942345988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KRISTY DANIELLE DYER PT

Provider Business Mailing Address
First Line	:	144 S CAROL MALONE BLVD
Second Line	:
City	:	GRAYSON
State	:	KY
Zip	:	41143-1352
Country	:	US
Telephone Number	:	606-474-7649
Fax Number	:	606-474-0855

Provider Business Practice Location Address
First Line	:	144 S CAROL MALONE BLVD
Second Line	:
City	:	GRAYSON
State	:	KY
Zip	:	41143-1352
Country	:	US
Telephone Number	:	606-474-7649
Fax Number	:	606-474-0855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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