Provider Demographics
NPI:1003895830
Name:DYMEK, KRISTIN E (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:DYMEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL ST2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-856-9510
Mailing Address - Fax:508-853-1907
Practice Address - Street 1:50 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:508-856-9510
Practice Address - Fax:508-853-1907
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110013683AMedicaid
042472266OtherTHREE RIVERS
4141642OtherMVP HEALTH CARE
7234636OtherAETNA US HEALTHCARE
Y67943OtherBLUE CARE ELECT
Y67943OtherBLUE SHIELD HMO BLUE
Y67943OtherBLUE SHIELD INDEMNITY
MA0318841Medicaid
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherONE HEALTH PLAN
35481155OtherCIGNA HEALTHSOURCE
2779432OtherCIGNA HEALTH PLAN
42397OtherFALLON COMMUNITY HEALTH
AA4052OtherHARVARD PILGRIM HEALTHCAR
AA4052OtherHARVARD PILGRIM HEALTHCAR