Provider Demographics
NPI:1497006993
Name:LIST, DAWN R (LMT)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:R
Last Name:LIST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 CHRISTOPHER PL
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2428
Mailing Address - Country:US
Mailing Address - Phone:614-204-4525
Mailing Address - Fax:
Practice Address - Street 1:3671 CHRISTOPHER PL
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2428
Practice Address - Country:US
Practice Address - Phone:614-204-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019357261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH33.19357OtherSTATE MEDICAL BD - MASSAGE THERAPY