Provider Demographics
NPI:1467447383
Name:CHIMENTO, DAWN (PT)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:CHIMENTO
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 1:2455 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4056
Mailing Address - Country:US
Mailing Address - Phone:718-791-2391
Mailing Address - Fax:844-791-7187
Practice Address - Street 1:2455 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-4056
Practice Address - Country:US
Practice Address - Phone:718-791-2391
Practice Address - Fax:844-791-7187
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY076KOtherBCBS
FLY076LZMedicare ID - Type Unspecified