Active NPI
Carol Jean Dickman, P.T.
- Physical Therapist
- Tucson, AZ
National Provider Identifier
1467401174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4210
- Practice address
- 1777 W Saint Mary'S Rd
Tucson, AZ 85745 - Phone
- (520) 884-9819
- Fax
- (520) 884-0175
- NPI assigned
- May 9, 2006
- Sex
- Male
- 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 | 4210 | AZ | Primary |
Addresses
Primary practice location
1777 W Saint Mary'S Rd
Tucson, AZ 85745
Mailing address
1777 W Saint Mary'S Rd
Tucson, AZ 85745
Phone (520) 884-9819
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 499617 | Medicaid | AZ |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4210 | AZ | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427328000000",
"number": "1467401174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1777 W SAINT MARY'S RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85745",
"telephone_number": "520-884-9819",
"fax_number": "520-884-0175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1777 W SAINT MARY'S RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85745",
"telephone_number": "520-884-9819",
"fax_number": "520-884-0175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKMAN",
"first_name": "CAROL",
"middle_name": "JEAN",
"name_prefix": "Ms.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-09",
"last_updated": "2015-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "4210",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "499617",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.