Provider Demographics
NPI:1386088862
Name:DICKSON, SAMANTHA JEAN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEAN
Last Name:DICKSON
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 1:175 INVERNESS DR W STE 150
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5068
Mailing Address - Country:US
Mailing Address - Phone:303-694-3333
Mailing Address - Fax:303-694-9666
Practice Address - Street 1:175 INVERNESS DR W STE 150
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5068
Practice Address - Country:US
Practice Address - Phone:303-694-3333
Practice Address - Fax:303-694-9666
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018753225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist