Agnes Garcia Dickenson
Individual provider Active NPI Geriatric Physical Therapist · Martin, TN
NPI 1689018244 · NPPES record last updated Apr 24, 2013
Key facts
- NPI
- 1689018244
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Physical Therapist 2251G0304X
- License
- TN3367 (TN)
- Practice address
- 215 Hawks Rd
Martin, TN 38237-2708 - Phone
- (731) 587-0072
- NPI assigned
- Apr 24, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TN3367 | TN | MD | Geriatric Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | TN3367 | TN | Yes |
Addresses
Primary practice location
215 Hawks Rd
Martin, TN 38237-2708
Mailing address
103 Shadow Wood CV
Martin, TN 38237-8148
Phone (731) 587-9482
Other providers in Martin, TN
- Nelson Ray Davis
- Shannon Deal
- George Fred Deaton
- Zachary Delaney
- Diagnostic Imaging Consultants,LTD
- Dignity Home Care
- Diversicare Leasing LP
- Tamara Dodd
- Donald P Wright & a Peter Bukeavich PTRS
- Daniel Wayne Donaldson II
All providers in Martin, TN · Geriatric Physical Therapist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.