Individual
DILLON SCOT KONVICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 KAHN ST, HALLETTSVILLE, TX 77964-2177
(361) 798-3606
Mailing address
1004 LAKESIDE DR, YOAKUM, TX 77995-4703
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2068048
TX
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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