Provider Demographics
NPI:1346946449
Name:DYMOND, CAITLYN ROSE (PTA)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ROSE
Last Name:DYMOND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1949
Mailing Address - Country:US
Mailing Address - Phone:570-208-2787
Mailing Address - Fax:570-287-2788
Practice Address - Street 1:840 W MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3337
Practice Address - Country:US
Practice Address - Phone:570-714-0933
Practice Address - Fax:570-714-0934
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI004296225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant