MEDICARE: AYANNA DICKERSON

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
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1184212599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYANNA DICKERSON

Provider Business Mailing Address
First Line	:	4840 A ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-3941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4840 A ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-3941
Country	:	US
Telephone Number	:	267-584-8026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2021
Last Update Date	:	01/02/2021

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Directions to “ AYANNA DICKERSON ” Practice Location

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