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NPI Code Detail

MEDICARE: DYRLY DY PT

MEDICARE: DYRLY DY 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
1225100000XPhysical Therapist2011040575MO

General Provider Information

NPI Number : 1952812430
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYRLY DY PT
Provider Business Mailing Address
First Line : 223 N MAIN ST APT 169
Second Line :
City : SIKESTON
State : MO
Zip : 63801-4211
Country : US
Telephone Number : 573-258-0718
Fax Number :
Provider Business Practice Location Address
First Line : 500 BARRETT DR
Second Line :
City : MALDEN
State : MO
Zip : 63863-1204
Country : US
Telephone Number : 573-276-3843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2017
Last Update Date : 03/17/2018

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Directions to “ DYRLY DY PT” Practice Location

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