Individual
MR. PAUL M DYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT, MOTR/L, ATC,
Contact information
Practice address
36 WINN DRIVE, SUITE #100, REXBURG, ID 83440
(208) 356-0174
(208) 356-0176
Mailing address
36 WINN DRIVE, SUITE #100, REXBURG, ID 83440
(208) 356-0174
(208) 356-0176
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1920
ID
225100000X
Physical Therapist
Primary
PT-1920
ID
2255A2300X
Athletic Trainer
AT-142
ID
225X00000X
Occupational Therapist
711
ID
225X00000X
Occupational Therapist
OT-711
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807100400
—
ID
05
—
80710500
—
ID
01
—
887408
DMBA
ID
Enumeration date
12/14/2005
Last updated
10/01/2010
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