Provider Demographics
NPI:1780656124
Name:DICKMAN, SCOTT ERIC (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ERIC
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 1:2727 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1527
Mailing Address - Country:US
Mailing Address - Phone:563-323-1177
Mailing Address - Fax:
Practice Address - Street 1:2035 BRIDGE AVE
Practice Address - Street 2:MIDWEST THERAPY
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2478
Practice Address - Country:US
Practice Address - Phone:563-326-1400
Practice Address - Fax:563-326-0700
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03033225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist