Individual
MR. RAYMOND EARL DYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
12320 HIGHWAY 44 BLDG 3F, GONZALES, LA 70737-2202
(225) 647-9505
(225) 647-9503
Mailing address
12320 HIGHWAY 44 BLDG 3F, GONZALES, LA 70737-2202
(225) 647-9505
(225) 647-9503
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
04375R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114103
—
LA
01
—
2513209
AETNA HMO PROVIDER#
LA
01
—
7981142
AETNA NON HMO PROVIDER#
LA
Enumeration date
10/25/2005
Last updated
11/02/2007
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