Provider Demographics
NPI:1275153512
Name:DICKENS, BRIAN D (PTA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:DICKENS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10973 COUNTY ROAD 152 W
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-8564
Mailing Address - Country:US
Mailing Address - Phone:903-352-9194
Mailing Address - Fax:
Practice Address - Street 1:18118 FM 344 W
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-6010
Practice Address - Country:US
Practice Address - Phone:903-590-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2055797225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant