Healthcare Provider Details

I. General information

NPI: 1154902039
Provider Name (Legal Business Name): KATHERINE DINGMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 06/18/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 LASKIN RD STE 706
VIRGINIA BEACH VA
23451-7504
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-0052
  • Fax: 757-481-1099
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214379
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: