Provider Demographics
NPI:1235814435
Name:DICKMAN, MADELYN MARIE (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:MARIE
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 LONGSTONE LN STE A
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1516
Mailing Address - Country:US
Mailing Address - Phone:410-982-6251
Mailing Address - Fax:410-982-6263
Practice Address - Street 1:2470 LONGSTONE LN STE A
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1516
Practice Address - Country:US
Practice Address - Phone:410-982-6251
Practice Address - Fax:410-982-6263
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist