Theresa M Dickerson, LMT, CBW

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT20901976 Issued in IN

Practice address

2625 N Meridian St
Indianapolis, IN 46208-7701

Phone

(678) 429-3197

NPI assigned

Sep 24, 2010

Last updated

Sep 24, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 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": "1285286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285286400000",
    "number": "1689982613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 KOEHNE ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021042",
            "telephone_number": "678-429-3197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 N MERIDIAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462087701",
            "telephone_number": "678-429-3197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "THERESA",
        "middle_name": "M",
        "credential": "LMT, CBW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-24",
        "last_updated": "2010-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173C00000X",
            "taxonomy_group": "",
            "desc": "Reflexologist",
            "state": "IN",
            "license": "MT20901976",
            "primary": false
        },
        {
            "code": "225500000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist",
            "state": "IN",
            "license": "MT20901976",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IN",
            "license": "MT20901976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MT20901976",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Elizabeth Dickerson
• Jena Dickerson
• Lauren Dickerson, PHARMD
• Sherria S Dickerson, MA MFT
• Tamyka Love Dickerson
• Dakotah Dickey
• Kathryn R Dickey, LCSW
• Marianne Dickey, CPNP
• Nicole Dickey
• Jacob John Dickinson, M.D.

• Massage Therapist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Massage Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; 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.