Mariliz Jimenez Dykstra, DPT

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

License

05011241A Issued in IN

Practice address

7573 W 121St Ave
Crown Point, IN 46307-8716

Phone

(219) 895-4103

NPI assigned

Mar 6, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1083172233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7573 W 121ST AVE",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078716",
            "telephone_number": "219-895-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7573 W 121ST AVE",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078716",
            "telephone_number": "219-895-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "MARILIZ",
        "middle_name": "JIMENEZ",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "IN",
            "license": "05011241A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crimsetta Lajeanna Dunn, LCSW
• U. Nalla B Durai, M.D.
• Dominique Dvojacki
• DVP Counseling and Behavioral Services , LLC
• Briana Dyer
• Timothy J Dykstra, CRNA
• Amy Lynn Eagens, OTR/L
• Chloe Edwards, RBT
• Julia Ann Edwards, NCSP, EIP
• Tiffany Nicole Edwards, LCSW

• Geriatric Physical Therapist in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Geriatric Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.