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General NPI Number Information
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NPI Number | 1750214235
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Entity Type | Individual
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Provider Name | MANDI DICKIE
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Gender | Female
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 2170 SOUTH AVE # B
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-7008
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Country | US
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Telephone | 530-539-6675
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Fax |
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Provider Business Mailing Address
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Address Line | 1890 10TH ST
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3824
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Country | US
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Telephone | 612-655-3144
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 305994
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License Number State | CA
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