Provider Demographics
NPI:1376948430
Name:DICKMAN, TODD ANDREW (PT)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANDREW
Last Name:DICKMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CHARLYN LN
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4457
Mailing Address - Country:US
Mailing Address - Phone:701-721-3984
Mailing Address - Fax:
Practice Address - Street 1:706 S MAIN AVE STE B
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3318
Practice Address - Country:US
Practice Address - Phone:701-721-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB223472Medicare PIN
CACA135509Medicare PIN