Provider Demographics
NPI:1770164659
Name:ZINGERMAN, DIMITRY ALEXANDER (DPT)
Entity type:Individual
Prefix:
First Name:DIMITRY
Middle Name:ALEXANDER
Last Name:ZINGERMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15501 BUSTLETON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1187
Mailing Address - Country:US
Mailing Address - Phone:215-742-7033
Mailing Address - Fax:
Practice Address - Street 1:15501 BUSTLETON AVE STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1187
Practice Address - Country:US
Practice Address - Phone:215-742-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist