Sara Michelle Dickerson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

016.0004032 Issued in IL

Practice address

620 Warrington Ave
Danville, IL 61832-5446

Phone

(217) 446-0660

Fax

(217) 446-9839

NPI assigned

Jun 10, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Select Outpatient Services Inc

  • Rehabilitation Clinic/Center
  • Newcastle, WA
  • NPI 1285909531
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1225358385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 FRONTAGE RD",
            "address_2": "SUITE 2415",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600931202",
            "telephone_number": "847-441-5593",
            "fax_number": "847-441-0734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 WARRINGTON AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618325446",
            "telephone_number": "217-446-0660",
            "fax_number": "217-446-9839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "SARA",
        "middle_name": "MICHELLE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-10",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "016.0004032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connie J Denmark, BS
• Dental Professionals of Illinois, P.C. (Danville Family Dental Care)
• Dental Professionals of Illinois, P.C. (North Vermillion Family Dental)
• Lana M Denton, PMHNP-BC
• Lori Ann Deyoung, PHD
• Katherine Dielman, LSW
• Rachael Dietkus
• Digital Hearing AIDS, Inc (Audibel Hearing Aids)
• Dillman Eye Care Associates SC
• Dillman Eye Care Optical Inc

• Physical Therapy Assistant in Danville, IL
• Providers in Danville, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.