Provider Demographics
NPI:1205824943
Name:DAWSON, JOHN MIKE (LAT,ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MIKE
Last Name:DAWSON
Suffix:
Gender:M
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:DUSON
Mailing Address - State:LA
Mailing Address - Zip Code:70529-4417
Mailing Address - Country:US
Mailing Address - Phone:337-406-2782
Mailing Address - Fax:
Practice Address - Street 1:1432 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2912
Practice Address - Country:US
Practice Address - Phone:337-232-7080
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.J002042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer