MEDICARE: SUZANNE DIMACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	3282	MA

General Provider Information

NPI Number	:	1972094738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE DIMACK

Provider Business Mailing Address
First Line	:	1762 MASS AVE STE 204
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-5328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1762 MASS AVE STE 204
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-5328
Country	:	US
Telephone Number	:	617-968-1233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2018
Last Update Date	:	05/28/2018

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Directions to “ SUZANNE DIMACK ” Practice Location

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