Individual
JEREMY ALBERT DYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.P.T.
Contact information
Practice address
1172 W HAYDEN AVE, HAYDEN, ID 83835-8700
(208) 773-8111
(208) 773-8385
Mailing address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 664-8194
(208) 667-1847
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2429
ID
225100000X
Physical Therapist
PT25530
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT2429
BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
04/11/2007
Last updated
06/05/2018
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