Provider Demographics
NPI:1144360793
Name:DWYER, HARROLD J (PH D, PT)
Entity type:Individual
Prefix:
First Name:HARROLD
Middle Name:J
Last Name:DWYER
Suffix:
Gender:M
Credentials:PH D, PT
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:H
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3010 BEECHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7731
Mailing Address - Country:US
Mailing Address - Phone:707-434-9389
Mailing Address - Fax:
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 11637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist