Provider Demographics
NPI:1134362031
Name:DYER, AMANDA MICHELLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:DYER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MICHELLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3608 SHADY ACRES LN TRLR 17
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-8761
Mailing Address - Country:US
Mailing Address - Phone:336-575-9513
Mailing Address - Fax:
Practice Address - Street 1:3608 SHADY ACRES LN TRLR 17
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-8761
Practice Address - Country:US
Practice Address - Phone:336-575-9513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4147225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant