Provider Demographics
NPI:1114905189
Name:DYLEWICZ, LINDA (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DYLEWICZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET2
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:2006-01-09
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7260590OtherAETNA US HEALTHCARE
35481155OtherCIGNA HEALTHSOURCE
797399OtherMVP HEALTH CARE
Y67970OtherBLUE SHIELD HMO BLUE
MA0395901Medicaid
1973097OtherFIRST HEALTH
2779432001OtherCIDGNA PAL ID
Y67970OtherBLUE CARE ELECT
Y68899OtherMEDICARE B
042472266OtherHEALTHCARE VALUE MGMT
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
AA4052OtherHARVARD PILGRIM
2779432OtherCIGNA HEALTH PLAN
63270OtherFALLON COMMUNITY HEALTH
MA0395901Medicaid