| NPI | 1790268274 |
|---|---|
| Former Name | HAVELY CAROLYN DICKERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC P17772) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P17772) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2021-01-13 |