Dominique Renee Dushuttle, MSPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT36739 Issued in FL

Practice address

2155 W Mustang Blvd
Beverly Hills, FL 34465-3520

Phone

(352) 746-0019

Fax

(352) 746-1035

NPI assigned

Sep 26, 2006

Last updated

Feb 19, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 9

Other names 1

• Mrs. Dominique Renee Kimball Former name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baylife Physical Therapy and Rehabilitation IncGroup PAC ID 9133170095, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Baylife Physical Therapy & Rehabilitation Inc

  • Physical Therapist
  • St Petersburg, FL
  • NPI 1760401434
  Medicare reassignment Care Compare group NPD
• Nature Coast Orthopaedics & Sports Medicine Clinic, PA

  • Orthopaedic Surgery Physician
  • Beverly Hills, FL
  • NPI 1588697551
  Medicare reassignment NPD
• Baylife Physical Therapy & Rehabilitation, Inc.

  • Specialist
  • Seminole, FL
  • NPI 1356747315
  NPD (past)
• Matrix Rehabilitation Delaware, Inc

  dba Barker Therapy & Rehabilitation

  • Physical Therapy Clinic/Center
  • Dover, DE
  • NPI 1013947217
  NPD (past)
• Physiotherapy Associates Inc

  dba Novacare Rehabilitation

  • Physical Therapy Clinic/Center
  • Bear, DE
  • NPI 1336443399
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1538260302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8477 S SUNCOAST BLVD",
            "city": "HOMOSASSA",
            "state": "FL",
            "postal_code": "344465028",
            "telephone_number": "352-382-7214",
            "fax_number": "352-382-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 W MUSTANG BLVD",
            "city": "BEVERLY HILLS",
            "state": "FL",
            "postal_code": "344653520",
            "telephone_number": "352-746-0019",
            "fax_number": "352-746-1035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 Atlantic Ave Suite 302",
            "address_purpose": "LOCATION",
            "city": "Oceanview",
            "state": "DE",
            "postal_code": "19970",
            "country_code": "US",
            "telephone_number": "302-537-7762",
            "fax_number": "302-537-7488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUSHUTTLE",
        "first_name": "DOMINIQUE",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT36739",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MD",
            "license": "19956",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "DE",
            "license": "J1-0001629",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "J5640001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI/UNITED HEALTHCARE",
            "identifier": "386902",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "61106203",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELAWARE PHYSICIANS CARE",
            "identifier": "1000037946",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPARTMENT OF LABOR",
            "identifier": "608308600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD GROUP #",
            "identifier": "DC4689",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST GROUP #",
            "identifier": "754AAT",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "900070997",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00200219",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOMINIQUE",
            "last_name": "KIMBALL",
            "middle_name": "RENEE",
            "prefix": "MRS.",
            "credential": "MSPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Delatola
• Odelsa Diaz Andres, M.D
• Donald L Dixon, M.D.
• Dr. Dionne Camille Orr & Associates PA
• Ronda Lynn Driskell
• Hannah Eddy
• Pat Elling, LMT
• Margaret A Enstrom, PTA
• Christopher Evans
• Tanya S Finch-Goodwin

• Physical Therapist in Beverly Hills, FL
• Providers in Beverly Hills, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.