Provider Demographics
NPI:1548283377
Name:TRAN, DINH DINH (PT)
Entity type:Individual
Prefix:
First Name:DINH
Middle Name:DINH
Last Name:TRAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WASHINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:617-719-7060
Mailing Address - Fax:781-961-4076
Practice Address - Street 1:30 KNEELAND ST
Practice Address - Street 2:3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1505
Practice Address - Country:US
Practice Address - Phone:617-719-7060
Practice Address - Fax:781-961-4076
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0395986Medicaid
MA307652OtherHARVARD PILGRIM
MAY67990OtherBLUECROSS BLUESHIELD
MA0024698OtherNEIGHBORHOOD HEALTH PLAN
MA686971OtherUNITED HEALTHCARE
MA0395986Medicaid