MEDICARE: SHARON S. DICKMANN MPT

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	2251H1200X	Hand Physical Therapist	1169569	TX

General Provider Information

NPI Number	:	1396838488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON S. DICKMANN MPT

Provider Business Mailing Address
First Line	:	2501 W WILLIAM CANNON DR
Second Line	:	BLDG. 1, SUITE #102
City	:	AUSTIN
State	:	TX
Zip	:	78745-5281
Country	:	US
Telephone Number	:	512-651-0301
Fax Number	:	512-651-0305

Provider Business Practice Location Address
First Line	:	2501 W WILLIAM CANNON DR
Second Line	:	BLDG. 1, SUITE #102
City	:	AUSTIN
State	:	TX
Zip	:	78745-5281
Country	:	US
Telephone Number	:	512-651-0301
Fax Number	:	512-651-0305

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/18/2010

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