Provider Demographics
NPI:1063585651
Name:DYE, KIPP KEVIN (MSPT)
Entity type:Individual
Prefix:MR
First Name:KIPP
Middle Name:KEVIN
Last Name:DYE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 920370
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-0005
Mailing Address - Country:US
Mailing Address - Phone:781-444-1290
Mailing Address - Fax:866-305-1388
Practice Address - Street 1:1237 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2615
Practice Address - Country:US
Practice Address - Phone:781-444-1290
Practice Address - Fax:866-305-1388
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1407803935Medicare ID - Type UnspecifiedPT GROUP NUMBER