Provider Demographics
NPI:1194947366
Name:DICKERSON, NANCY Y (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:Y
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 ARCTIC BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4580
Mailing Address - Country:US
Mailing Address - Phone:907-550-3036
Mailing Address - Fax:907-563-3172
Practice Address - Street 1:3330 ARCTIC BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4580
Practice Address - Country:US
Practice Address - Phone:907-550-3036
Practice Address - Fax:907-563-3172
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist