Individual
JUSTIN BRIAN DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1303 MCCULLOUGH AVE STE 600, SAN ANTONIO, TX 78212-5608
(210) 508-9217
Mailing address
10415 BEACHBALL BEND, CONVERSE, TX 78109
(480) 205-6426
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT8564
TX
Other
Enumeration date
09/23/2022
Last updated
09/23/2022
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