Provider Demographics
NPI:1083672687
Name:DIKSA, BRIAN THOMAS (DPT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:THOMAS
Last Name:DIKSA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1000 CONESTOGA RD
Mailing Address - Street 2:APT #B229
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1551
Mailing Address - Country:US
Mailing Address - Phone:302-690-9243
Mailing Address - Fax:
Practice Address - Street 1:100 PRESIDENTIAL BLVD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1108
Practice Address - Country:US
Practice Address - Phone:610-668-0904
Practice Address - Fax:610-668-0668
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist