Provider Demographics
NPI:1710221577
Name:DIZON, MARIE-KARL VALENCIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE-KARL
Middle Name:VALENCIA
Last Name:DIZON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 ALLEGHANEY ST
Mailing Address - Street 2:APT. #4
Mailing Address - City:BURLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:66839-2250
Mailing Address - Country:US
Mailing Address - Phone:620-203-1501
Mailing Address - Fax:
Practice Address - Street 1:601 CROSS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KS
Practice Address - Zip Code:66839-1105
Practice Address - Country:US
Practice Address - Phone:620-364-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist