Provider Demographics
NPI:1255563680
Name:DICKMEYER, BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:DICKMEYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOYNTON HEALTH SERVICE
Mailing Address - Street 2:410 CHURCH STREET SE
Mailing Address - City:MINNEAPLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-8400
Mailing Address - Fax:612-677-3321
Practice Address - Street 1:BOYNTON HEALTH
Practice Address - Street 2:410 CHURCH STREET SE
Practice Address - City:MINNEAPLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-8400
Practice Address - Fax:612-677-3321
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 6019225100000X
WAPT60103916225100000X
MN9815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00836811OtherRR MEDICARE
WA8568024Medicaid
OR0253485OtherWASHINGTON L&I
OR500611221Medicaid
WAP00836811OtherRR MEDICARE
ORR162919Medicare PIN
WAG8884373Medicare PIN
WAG8886940Medicare PIN
OR500611221Medicaid