Individual provider · NPI-1

Jesse Lee Dimick, PTA, LATC

Physical Medicine & Rehabilitation, Sports Medicine · West Roxbury, MA

NPI number1386680809
StatusActive
Last updated in NPPESJul 13, 2026

Details

NPI
1386680809
Entity type
Individual (NPI-1)
Name
Mr. Jesse Lee Dimick
Credential
PTA, LATC
Sex
Male
Sole proprietor
No
Enumeration date
Jun 22, 2006
Last updated
Jul 13, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2081S0010X Physical Medicine & Rehabilitation, Sports Medicine1708MAYes

Practice location

43 Redlands Rd
West Roxbury, MA 02132-1506

Phone 617-892-2749

Mailing address

43 Redlands Rd
West Roxbury, MA 02132-1506

Phone 617-892-2749

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