Provider Demographics
NPI:1073170502
Name:DICKENSON, SCOTT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:DICKENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SHEARER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2746
Mailing Address - Country:US
Mailing Address - Phone:215-370-6838
Mailing Address - Fax:
Practice Address - Street 1:1500 HORIZON DR STE 102E
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3966
Practice Address - Country:US
Practice Address - Phone:215-712-0300
Practice Address - Fax:302-831-4468
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist