Basic Information
| Provider Information | |||||||||
| NPI: | 1114905189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYLEWICZ | ||||||||
| FirstName: | LINDA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET2 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088569510 | ||||||||
| FaxNumber: | 5088531907 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 GOLD STAR BLVD | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088569510 | ||||||||
| FaxNumber: | 5088531907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 11/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3522 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7260590 | 01 | AETNA US HEALTHCARE | OTHER | 35481155 | 01 | CIGNA HEALTHSOURCE | OTHER | 797399 | 01 | MVP HEALTH CARE | OTHER | Y67970 | 01 | BLUE SHIELD HMO BLUE | OTHER | 0395901 | 05 | MA | MEDICAID | 1973097 | 01 | FIRST HEALTH | OTHER | 2779432001 | 01 | CIDGNA PAL ID | OTHER | Y67970 | 01 | BLUE CARE ELECT | OTHER | Y68899 | 01 | MEDICARE B | OTHER | 042472266 | 01 | HEALTHCARE VALUE MGMT | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | AA4052 | 01 | HARVARD PILGRIM | OTHER | 2779432 | 01 | CIGNA HEALTH PLAN | OTHER | 63270 | 01 | FALLON COMMUNITY HEALTH | OTHER |