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General NPI Number Information
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NPI Number | 1972793966
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Entity Type | Individual
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Provider Name | ALTON AARON DICKSON P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 4801 N. BUTLER, SUITE 2000 AND GUARDIAN ANGEL
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-564-9002
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX # 15012
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-564-9002
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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 | A-0530
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License Number State | NM
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