THERESA M DICKERSON LMT CBW NPI 1689982613

NPI Information

NPI: 1689982613
Provider Name: THERESA M DICKERSON, LMT, CBW
Classification: Massage Therapist - 225700000X
Entity Type: Individual
Address:
2625 N MERIDIAN ST
INDIANAPOLIS, IN
ZIP 46208
Phone: (678) 429-3197
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Theresa M Dickerson, LMT, CBW is a massage therapist in Indianapolis, IN. The provider is an individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. Theresa M Dickerson, LMT, CBW NPI is 1689982613. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2625 N MERIDIAN ST
INDIANAPOLIS, IN
ZIP 46208-701
Phone: (678) 429-3197

The enumeration date for this NPI number is 9/24/2010 and was last updated on 9/24/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	173C00000X	Reflexologist	MT20901976	INDIANA	No
2	225500000X	Specialist/Technologist	MT20901976	INDIANA	No
3	225700000X	Massage Therapist	MT20901976	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	MT20901976	OTHER	INDIANA	STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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