Provider Demographics
NPI:1467540237
Name:DITMAR, TERRY (PT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:DITMAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 DENSLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3103
Mailing Address - Country:US
Mailing Address - Phone:413-526-9969
Mailing Address - Fax:413-526-9960
Practice Address - Street 1:80 DENSLOW RD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-3103
Practice Address - Country:US
Practice Address - Phone:413-526-9969
Practice Address - Fax:413-526-9960
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000035309OtherBOSTON HEALTHNET
MA103355100OtherDEPT. OF LABOR
MA11222700OtherCAQH
MA5488334OtherCIGNA
MA043527OtherCONNECTICARE-GROUP NO.
MA043527497OtherPHCS
MA043527497OtherPIONEER
MA043527497OtherGREATWEST
MA043527497OtherNORTH REGION
MA28117OtherHNE
MA3276068OtherOXFORD
MA468825OtherTUFTS
MA043527497OtherCONSOLIDATED-GROUP NO.
MA972730OtherNETWORK
MAAA49027OtherHARVARD PILGRIM
MA0300675Medicaid
MA080005754MA02OtherANTHEM
MA4214910OtherAETNA
MAY66833OtherBLUE CROSS BLUE SHIELD
MA650021641OtherRAILROAD MEDICARE
MA9715568Medicaid
MA043527497OtherUNICARE
MA11222700OtherCAQH
MA4214910OtherAETNA
MA0300675Medicaid