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General NPI Number Information
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NPI Number | 1558495846
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Entity Type | Individual
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Provider Name | JENNIFER MARIE DICKSON DPT, OMPT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 67962 VAN DYKE RD
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City | ROMEO
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State | MI
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Zip | 48065-5163
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Country | US
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Telephone | 586-336-4022
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Fax | 586-336-4082
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Provider Business Mailing Address
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Address Line | 878 S ROCHESTER RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-2767
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Country | US
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Telephone | 248-601-9207
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Fax | 248-650-8670
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 5501011225
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License Number State | MI
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