Provider Demographics
NPI:1518412097
Name:DICK, DAWN VICTORIA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:VICTORIA
Last Name:DICK
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 1:13080 BELCHER RD S STE C9
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1658
Mailing Address - Country:US
Mailing Address - Phone:727-222-6282
Mailing Address - Fax:
Practice Address - Street 1:13080 BELCHER RD S STE C9
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1658
Practice Address - Country:US
Practice Address - Phone:727-222-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 372600000X
FL374U00000X
FLMA60744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide