Provider Demographics
NPI:1477925634
Name:MATHIS, DENNIS TUCKER (ATC, L)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:TUCKER
Last Name:MATHIS
Suffix:
Gender:M
Credentials:ATC, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-6948
Mailing Address - Country:US
Mailing Address - Phone:850-638-3387
Mailing Address - Fax:850-415-1967
Practice Address - Street 1:1567 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6948
Practice Address - Country:US
Practice Address - Phone:850-638-3387
Practice Address - Fax:850-415-1967
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer