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General NPI Number Information
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NPI Number | 1669105003
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Entity Type | Individual
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Provider Name | DEION TERELL MCKITTRICK ATC
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Gender | Male
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Dates
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Enumeration Date | 07/04/2022
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Last Update Date | 07/04/2022
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Provider Practice Location Address
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Address Line | 411 N WASHINGTON AVE STE 5000
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City | DALLAS
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State | TX
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Zip | 75246-1792
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Country | US
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Telephone | 214-818-2534
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 BREANNA WAY
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City | LITTLE ELM
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State | TX
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Zip | 75068-5828
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Country | US
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Telephone | 918-409-8334
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000051899
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License Number State | TX
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