Provider Demographics
NPI:1184667321
Name:DZIKOWSKI, SHIRLEY J (PT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:J
Last Name:DZIKOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CANVASBACK RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8134
Mailing Address - Country:US
Mailing Address - Phone:704-677-7905
Mailing Address - Fax:704-677-7904
Practice Address - Street 1:503 CANVASBACK RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8134
Practice Address - Country:US
Practice Address - Phone:704-677-7905
Practice Address - Fax:704-677-7904
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90631OtherMEDCOST
NC7132147OtherAETNA
NC1009JOtherBCBS
NC7210180Medicaid