Provider Demographics
NPI:1205298239
Name:DIMACUHA, CAROLE ANN
Entity type:Individual
Prefix:
First Name:CAROLE ANN
Middle Name:
Last Name:DIMACUHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DELAWARE VETERANS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-5395
Mailing Address - Country:US
Mailing Address - Phone:302-259-4167
Mailing Address - Fax:
Practice Address - Street 1:100 DELAWARE VETERANS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5395
Practice Address - Country:US
Practice Address - Phone:302-259-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE225100000X
CAAT9664225200000X
DEJ1-0003416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant