Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 19576 | MD |
NPI | 1083183792 |
---|---|
Provider Name | Denise Ann Dickenson |
First Address | Olney, MD 20832-1260 |
Second Address | Olney, MD 20832-1260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2018 |
Last Update Date | 26/11/2018 |