Provider Demographics
NPI:1437132289
Name:DICKMAN, AUDREY BETH (MED, ATC)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:BETH
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WERNER ST
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-1624
Mailing Address - Country:US
Mailing Address - Phone:610-780-5940
Mailing Address - Fax:610-370-0518
Practice Address - Street 1:201 E 37TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3131
Practice Address - Country:US
Practice Address - Phone:610-779-3060
Practice Address - Fax:610-370-0518
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0033502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer