Basic Information
| Provider Information | |||||||||
| NPI: | 1073170502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICKENSON | ||||||||
| FirstName: | SCOTT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 SHEARER ST | ||||||||
| Address2: | |||||||||
| City: | NORTH WALES | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194542746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153706838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 HORIZON DR STE 102E | ||||||||
| Address2: | |||||||||
| City: | CHALFONT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189143966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157120300 | ||||||||
| FaxNumber: | 3028314468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.