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General NPI Number Information
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NPI Number | 1164766895
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Entity Type | Individual
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Provider Name | DANNY DUANE DIMMITT P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 6390 RIVERBIRCH PL
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City | COLUMBIA
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State | MO
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Zip | 65202-5802
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Country | US
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Telephone | 573-881-4606
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Fax |
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Provider Business Mailing Address
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Address Line | 6390 RIVERBIRCH PL
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City | COLUMBIA
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State | MO
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Zip | 65202-5802
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Country | US
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Telephone | 573-881-4606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160005950
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-0816
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License Number State | NM
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