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General NPI Number Information
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NPI Number | 1063180438
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Entity Type | Individual
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Provider Name | SEAN DICKERSON
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Gender | Male
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 189 W MAIN ST
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City | FOREST CITY
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State | NC
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Zip | 28043-3051
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Country | US
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Telephone | 828-417-0090
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412313
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City | BOSTON
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State | MA
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Zip | 02241-5424
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Country | US
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Telephone | 914-294-4050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP034948T
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12056
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P20741
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License Number State | NC
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