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NPI Code Detail

MEDICARE: MRS. CONSTANCE LOU DYKHOUSE PT

MEDICARE:  MRS. CONSTANCE LOU DYKHOUSE  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT11074CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT11074OTHERCAPT BOARD OF CA

General Provider Information

NPI Number : 1407858210
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CONSTANCE LOU DYKHOUSE PT
Provider Business Mailing Address
First Line : PO BOX 1084
Second Line :
City : TEMPLETON
State : CA
Zip : 93465-1084
Country : US
Telephone Number : 805-434-2748
Fax Number : 805-237-2416
Provider Business Practice Location Address
First Line : 1414 PARK ST
Second Line :
City : PASO ROBLES
State : CA
Zip : 93446-2160
Country : US
Telephone Number : 805-237-0272
Fax Number : 805-237-2416
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. CONSTANCE LOU DYKHOUSE PT” Practice Location

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