David Dickerson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06006507A Issued in IN

Practice address

118 Medical Dr
Carmel, IN 46032-3323

Phone

(773) 957-6184

NPI assigned

Sep 15, 2022

Last updated

Sep 15, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1336861483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 MEDICAL DR",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 MEDICAL DR",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323323",
            "telephone_number": "773-957-6184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "DAVID",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06006507A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "CarDon",
            "affiliation": "N",
            "endpointDescription": "CarDon",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "118 Medical Dr",
            "city": "Carmel",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460323323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diana Clarke, LLC (Life Balance Therapy)
• David Diaz, MD
• Michael Ryan Dick
• Melissa M Dicke
• Alicia T Dickens
• Jennifer Nicole Dickerson, MS, CGC
• Jessica Dickerson, PTA
• Grace Dickinson, MSW, LSW
• Catherine Dicks, LMT
• Robert J Dickson, D.D.S.

• Physical Therapy Assistant in Carmel, IN
• Providers in Carmel, IN by specialty
• Physical Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.