Provider Demographics
NPI:1386090249
Name:DISMUKE, DENNY (LMT)
Entity type:Individual
Prefix:MR
First Name:DENNY
Middle Name:
Last Name:DISMUKE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 WILBUR RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:MS
Mailing Address - Zip Code:39332-3198
Mailing Address - Country:US
Mailing Address - Phone:601-697-6748
Mailing Address - Fax:
Practice Address - Street 1:2000 15TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4138
Practice Address - Country:US
Practice Address - Phone:601-697-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLMT2347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist