Healthcare Provider Details

I. General information

NPI: 1215320411
Provider Name (Legal Business Name): D'ODRIC SYKES ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 PEBBLE RD
DUNCANVILLE TX
75116-3233
US

IV. Provider business mailing address

519 PEBBLE RD
DUNCANVILLE TX
75116-3233
US

V. Phone/Fax

Practice location:
  • Phone: 469-245-8091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: