Provider Demographics
NPI:1871561365
Name:DICKMAN, JANELLE (PT)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3403
Mailing Address - Country:US
Mailing Address - Phone:563-742-5900
Mailing Address - Fax:563-742-5980
Practice Address - Street 1:3540 E 46TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3403
Practice Address - Country:US
Practice Address - Phone:563-742-5900
Practice Address - Fax:563-742-5980
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012419225100000X
IA03198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist