Active NPI
Pamela Durene-Ardrey Dickerman, P.T.
- Physical Therapist
- Riverside, CA
National Provider Identifier
1801004130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT19082
- Practice address
- 10800 Magnolia Ave
Riverside, CA 92505-3043 - Phone
- (951) 353-5069
- Fax
- (951) 353-4044
- NPI assigned
- May 18, 2007
- Sex
- Female
- 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 | PT19082 | CA | Primary |
Addresses
Primary practice location
10800 Magnolia Ave
Riverside, CA 92505-3043
Mailing address
2181 Monroe St
Riverside, CA 92504-5209
Phone (951) 785-8157
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 |
|---|---|---|---|
| PT19082 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801004130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2181 MONROE ST",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925045209",
"telephone_number": "951-785-8157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10800 MAGNOLIA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925053043",
"telephone_number": "951-353-5069",
"fax_number": "951-353-4044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERMAN",
"first_name": "PAMELA",
"middle_name": "DURENE-ARDREY",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT19082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.