Provider Demographics
NPI:1518565274
Name:DIMICK, MICHAEL CHAD CASCADE (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHAD CASCADE
Last Name:DIMICK
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:CANYON DAM
Mailing Address - State:CA
Mailing Address - Zip Code:95923-0099
Mailing Address - Country:US
Mailing Address - Phone:503-913-1750
Mailing Address - Fax:
Practice Address - Street 1:78 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971
Practice Address - Country:US
Practice Address - Phone:530-283-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018840225100000X
CA299619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist