Individual
SHANTIL DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05012095A
IN
225100000X
Physical Therapist
Primary
PT016442
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
ANTHEM
—
05
—
PENDING
—
IN
05
—
PENDING
—
OH
Enumeration date
02/06/2017
Last updated
08/01/2018
Update your record
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