Provider Demographics
NPI:1205282704
Name:DYCUS, ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DYCUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:DYCUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:236 LEONORA DR STE 600
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-2807
Mailing Address - Country:US
Mailing Address - Phone:901-634-2330
Mailing Address - Fax:
Practice Address - Street 1:236 LEONORA DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-2807
Practice Address - Country:US
Practice Address - Phone:901-634-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11071225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist