Individual
MR. ALEX HEATH DIBBLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.C., L.A.T.
Contact information
Practice address
PO BOX 91705, LAKE CHARLES, LA 70609-0001
(337) 477-0248
(337) 477-8964
Mailing address
4181 HICKORY BRANCH RD, LAKE CHARLES, LA 70611-3502
(337) 855-4404
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
J00288
LA
Other
Enumeration date
06/11/2007
Last updated
07/08/2007
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