GWENETTA J DICKERSON (NPI# 1730681800) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730681800 |
| Entity Type | Individual |
| Full Name | GWENETTA J DICKERSON |
| Practice Address |
100 Eagle Crk Collinsville IL 62234-4395 |
| Practice Telephone | 3149336369 |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-03-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | 227018739 | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
100 EAGLE CRK |
| City | COLLINSVILLE |
| State | IL |
| Zip Code | 62234-4395 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730791005 | Kendall Kotter | Pharmacist | 401 Beltline Rd, Collinsville, IL 62234 | 2020-08-18 |
| 1851804207 | Apex Physical Therapy, LLC | Clinic/Center | 1095 Beltine Rd., Ste. 400, Collinsville, IL 62234 | 2017-11-08 |
| 1205361110 | Pc Associates, LLC | Family Medicine | 1095 Beltline Road, Suite 500, Collinsville, IL 62234 | 2017-04-28 |
| 1538405451 | Joan M Polwort | Pharmacist | 801 Braidwood Ct, Collinsville, IL 62234 | 2012-12-20 |
| 1275818080 | Stephen Scott Branding | Pharmacist | 401 Beltline Rd., Collinsville, IL 62234 | 2011-10-13 |
| 1447534417 | Lindsay Eakin | Pharmacist | 401 Beltline, Collinsville, IL 62234 | 2011-10-07 |
| 1700171568 | Patrick Joseph Swierczek | Social Worker | 820 St. Louis Rd Apt#232, Collinsville, IL 62234 | 2011-06-09 |
| 1366670887 | Susan M. Smith Dc LLC | Chiropractor | 226 South Morrison, Collinsville, IL 62234 | 2009-06-23 |
| 1649418492 | Lynette M Patton | Counselor | 415 W Main St Ste 3, Collinsville, IL 62234 | 2009-02-02 |
| 1558506626 | Kimberly Jean Miller | Counselor | Meadow Heights Professional Park, Suite 2b, Collinsvile, IL 62234 | 2008-12-03 |
| Find all providers in zip 62234 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902438096 | Marvin Stacy Wolfe | Massage Therapist | 2051 Daniels Creek Rd, Collinsville, VA 24078-2912 | 2020-02-07 |
| 1487719621 | Jeanne Lamb | Massage Therapist | 352 S Avenue F, Collinsville, OK 74021-3649 | 2006-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627872 | Patricia Pollard | Massage Therapist | 4437 N Lowell Ave Apt 2, Chicago, IL 60630-4103 | 2020-10-23 |
| 1497354104 | Lola Sanders | Massage Therapist | 844 Wilshire Dr, Belleville, IL 62223-2623 | 2020-10-22 |
| 1003415001 | Amanda L Klimczak | Massage Therapist | 1231 Ridgeland Ave, Berwyn, IL 60402-1142 | 2020-10-21 |
| 1093314148 | Jody Lee Hazel | Massage Therapist | 1750 E Colborn Camp Ln, Noble, IL 62868-2348 | 2020-10-20 |
| 1194323352 | Vanina Barnett | Massage Therapist | 112 Sussex Cir, Schaumburg, IL 60193-1835 | 2020-10-10 |
| 1063029676 | Natasha White | Massage Therapist | 8235 S Kingston Ave, Chicago, IL 60617-1909 | 2020-09-28 |
| 1407463029 | Danielle Wright | Massage Therapist | 132 S Water St Ste 430, Decatur, IL 62523-2305 | 2020-09-28 |
| 1316554272 | Paula Marie Zaloga-nowak | Massage Therapist | 4942 N Melvina Ave, Chicago, IL 60630-2908 | 2020-09-24 |
| 1780291872 | Jennifer Marshall | Massage Therapist | 6920 W 110th St, Worth, IL 60482-1425 | 2020-09-23 |
| 1326654690 | Helene Decourchelle | Massage Therapist | 3524 N Marshfield Ave Ph, Chicago, IL 60657-1248 | 2020-09-21 |
| Find all providers with the same taxonomy | ||||
| City | COLLINSVILLE |
| Zip Code | 62234 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.