Provider Demographics
NPI:1558982090
Name:DIMAYUGA THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:DIMAYUGA THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:978-501-0414
Mailing Address - Street 1:1913 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2417
Mailing Address - Country:US
Mailing Address - Phone:617-963-0917
Mailing Address - Fax:617-963-0917
Practice Address - Street 1:1913 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2417
Practice Address - Country:US
Practice Address - Phone:617-963-0917
Practice Address - Fax:617-963-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health