Provider Demographics
NPI:1699084798
Name:DICKINSON, LAURA LEE (DPT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:MID-NEBRASKA PHYSICAL THERAPY & SPORTS CENTER, P.C.
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-6036
Mailing Address - Country:US
Mailing Address - Phone:308-534-0999
Mailing Address - Fax:308-534-7299
Practice Address - Street 1:120 WEST LEOTA STREET
Practice Address - Street 2:MID-NEBRASKA PHYSICAL THERAPY & SPORTS CENTER, P.C.
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69103-6036
Practice Address - Country:US
Practice Address - Phone:308-534-0999
Practice Address - Fax:308-534-7299
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470841233-32Medicaid