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General NPI Number Information
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NPI Number | 1558982090
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Entity Type | Organization
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Legal Business Name | DIMAYUGA THERAPY SERVICES, INC.
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 1913 COMMONWEALTH AVE
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City | AUBURNDALE
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State | MA
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Zip | 02466-2417
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Country | US
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Telephone | 617-963-0917
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Fax | 617-963-0917
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Provider Business Mailing Address
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Address Line | 1913 COMMONWEALTH AVE
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City | AUBURNDALE
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State | MA
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Zip | 02466-2417
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Country | US
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Telephone | 617-963-0917
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Fax | 617-963-0917
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Authorized Official
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Title or Position | PRESIDENT
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Name | TREVOR LARSEN
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Credential | PT, DPT
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Telephone | 978-501-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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