Provider Demographics
NPI:1932229499
Name:DICKSON, HYLA LEANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:HYLA
Middle Name:LEANN
Last Name:DICKSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:HYLA
Other - Middle Name:LEANN
Other - Last Name:HITCHCOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:9239 N SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1566
Mailing Address - Country:US
Mailing Address - Phone:503-309-2191
Mailing Address - Fax:
Practice Address - Street 1:8933 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3003
Practice Address - Country:US
Practice Address - Phone:503-286-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10476225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist