Provider Demographics
NPI:1932437175
Name:DICKSON, MICHELLE L (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:DICKSON
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 1:115 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1773
Mailing Address - Country:US
Mailing Address - Phone:570-586-1188
Mailing Address - Fax:570-585-7323
Practice Address - Street 1:115 E GROVE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1773
Practice Address - Country:US
Practice Address - Phone:570-586-1188
Practice Address - Fax:570-585-7323
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist