Provider Demographics
NPI:1497867766
Name:DIMMER, PATRICK RAYMOND (PT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:RAYMOND
Last Name:DIMMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:34209 BANBURY ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2219
Mailing Address - Country:US
Mailing Address - Phone:248-661-9347
Mailing Address - Fax:248-553-0010
Practice Address - Street 1:28595 ORCHARD LAKE RD
Practice Address - Street 2:100
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2977
Practice Address - Country:US
Practice Address - Phone:248-553-0010
Practice Address - Fax:248-553-3578
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501008436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist