Provider Demographics
NPI:1245715556
Name:DYMOND, KAYSE LYNNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAYSE
Middle Name:LYNNE
Last Name:DYMOND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6146 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SWIFTWATER
Mailing Address - State:PA
Mailing Address - Zip Code:18370-7768
Mailing Address - Country:US
Mailing Address - Phone:570-977-9078
Mailing Address - Fax:
Practice Address - Street 1:6146 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SWIFTWATER
Practice Address - State:PA
Practice Address - Zip Code:18370-7768
Practice Address - Country:US
Practice Address - Phone:570-977-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022572225100000X
DEJ10003782225100000X
NJ40QA01722100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist