Provider Demographics
NPI:1861911281
Name:DICKINSON, PHILIP MURRAY
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:MURRAY
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 STEVENS DR APT 718
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2161
Mailing Address - Country:US
Mailing Address - Phone:281-881-2196
Mailing Address - Fax:
Practice Address - Street 1:83 KEENE RD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-5006
Practice Address - Country:US
Practice Address - Phone:509-737-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60756548225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist