Provider Demographics
NPI:1366619181
Name:DYER-MCKIMMEY, ADRIENNE MICHELE (LMT)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:MICHELE
Last Name:DYER-MCKIMMEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:MICHELE
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:317 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-4519
Mailing Address - Country:US
Mailing Address - Phone:484-891-0568
Mailing Address - Fax:484-891-0568
Practice Address - Street 1:317 S 16TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-4519
Practice Address - Country:US
Practice Address - Phone:973-632-5827
Practice Address - Fax:973-632-5827
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018623-1225700000X
PAMSG003217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist