Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01358100 | NJ |
NPI | 1003129156 |
---|---|
Provider Name | Heather Dimenno |
First Address | Boston, MA 02241-6495 |
Second Address | Montague, NJ 07827-3045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2010 |
Last Update Date | 19/07/2010 |