Provider Demographics
NPI:1104113356
Name:DIMONT, IRVING BARRY (PT)
Entity type:Individual
Prefix:MR
First Name:IRVING
Middle Name:BARRY
Last Name:DIMONT
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 1:797 E RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-0616
Mailing Address - Country:US
Mailing Address - Phone:559-434-6717
Mailing Address - Fax:
Practice Address - Street 1:797 E RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-0616
Practice Address - Country:US
Practice Address - Phone:559-434-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist