Provider Demographics
NPI:1730503848
Name:DICKMAN, MANDY L
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:L
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E LANTANA RD
Mailing Address - Street 2:APT 6
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2979
Mailing Address - Country:US
Mailing Address - Phone:561-891-0244
Mailing Address - Fax:
Practice Address - Street 1:221 E LANTANA RD
Practice Address - Street 2:APT 6
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2979
Practice Address - Country:US
Practice Address - Phone:561-891-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 48222225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist