Individual
KEITH A DYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
40 E CHERRY ST, SCOTTSBURG, IN 47170-1814
(812) 752-6202
(812) 752-9533
Mailing address
PO BOX 10, BROWNSTOWN, IN 47220-0010
(812) 358-1714
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05005009A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000363472
ANTHEM PROVIDER NUMBER
IN
05
—
200476840
—
IN
Enumeration date
10/13/2006
Last updated
01/04/2012
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