Provider Demographics
NPI:1366827883
Name:DICKENS, LATANIS WILLIAMSON (DPT)
Entity Type:Individual
Prefix:
First Name:LATANIS
Middle Name:WILLIAMSON
Last Name:DICKENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LATANIS
Other - Middle Name:D
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1540 E ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5870
Mailing Address - Country:US
Mailing Address - Phone:252-364-2806
Mailing Address - Fax:252-364-2863
Practice Address - Street 1:1248 HUFFMAN MILL RD STE 200
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-226-0660
Practice Address - Fax:336-227-6327
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist