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Individual

BENJAMIN LANE DICKERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT, DPT, ATC

Contact information

Practice address
3207 HILLIARD ROME RD, HILLIARD, OH 43026
(614) 850-0680
Mailing address
1520 W 6TH AVE APT 13, COLUMBUS, OH 43212-2469
(419) 618-5565

Taxonomy

Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
8403
SC
2251S0007X
Sports Physical Therapist
Primary
PT.015069
OH
2255A2300X
Athletic Trainer
BOC154302
SC

Other

Enumeration date
04/08/2019
Last updated
08/07/2019
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