Organization
FARMMOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY DICKASON MD (PRESIDENT)
(863) 409-9680
Entity
Organization
Contact information
Practice address
3212 TENOROC MINE RD, LAKELAND, FL 33805-8525
(863) 409-9680
Mailing address
3212 TENOROC MINE RD, LAKELAND, FL 33805-8525
(863) 409-9680
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
04/02/2017
Last updated
04/02/2017
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