Active NPI
Holly Kristen Dickson, P.T.
- Physical Therapist
- Roanoke, TX
National Provider Identifier
1013968882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1136273
- Practice address
- 2800 E.State Hwy 114
Suite 220
Roanoke, TX 76262-5624 - Phone
- (817) 491-3403
- Fax
- (817) 491-3308
- NPI assigned
- May 15, 2006
- Last updated
- Jun 20, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1136273 | TX | Primary |
Addresses
Primary practice location
2800 E.State Hwy 114
Suite 220
Roanoke, TX 76262-5624
Mailing address
311 Skyline Dr
Trophy Club, TX 76262-5624
Phone (817) 707-7025
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85811T | Other | TX | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DPT Holdings, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340150400000",
"number": "1013968882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "311 SKYLINE DR",
"city": "TROPHY CLUB",
"state": "TX",
"postal_code": "762625624",
"telephone_number": "817-707-7025",
"fax_number": "817-491-3807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 E.STATE HWY 114",
"address_2": "SUITE 220",
"city": "ROANOKE",
"state": "TX",
"postal_code": "762625624",
"telephone_number": "817-491-3403",
"fax_number": "817-491-3308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKSON",
"first_name": "HOLLY",
"middle_name": "KRISTEN",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-15",
"last_updated": "2012-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1136273",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "85811T",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.