Provider Demographics
NPI:1366470031
Name:DIMICK, FRANK TODD (ATC, LAT, LPTA)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:TODD
Last Name:DIMICK
Suffix:
Gender:M
Credentials:ATC, LAT, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 MEMORIAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4070
Mailing Address - Country:US
Mailing Address - Phone:208-232-4267
Mailing Address - Fax:208-232-4268
Practice Address - Street 1:560 MEMORIAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4070
Practice Address - Country:US
Practice Address - Phone:208-232-4267
Practice Address - Fax:208-232-4268
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT0942255A2300X
IDPTA-2676225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer