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NPI Code Detail

MEDICARE: PETER B DICKINSON MS, PT, SCS

MEDICARE: PETER B DICKINSON MS, PT, SCS
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 TherapistPT00007732WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DI5861OTHERWAREGENCE RIDER
20125007OTHERWALABOR & INDUSTRIES
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104808559
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER B DICKINSON MS, PT, SCS
Provider Business Mailing Address
First Line : PO BOX 814
Second Line :
City : WINTHROP
State : WA
Zip : 98862-0814
Country : US
Telephone Number : 509-996-8234
Fax Number : 509-996-2193
Provider Business Practice Location Address
First Line : 202 WHITE AVE
Second Line :
City : WINTHROP
State : WA
Zip : 98862-9774
Country : US
Telephone Number : 509-996-8234
Fax Number : 509-996-2193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 10/10/2007

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