Provider Demographics
NPI:1871789552
Name:DYER, BETHANY ANN (PHD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:DYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1912
Mailing Address - Country:US
Mailing Address - Phone:315-422-6828
Mailing Address - Fax:
Practice Address - Street 1:1106 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1912
Practice Address - Country:US
Practice Address - Phone:315-422-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist