Provider Demographics
NPI:1205336021
Name:DALLINGER, ANDREW (LAT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:DALLINGER
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 BURMEISTER RD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-3705
Mailing Address - Country:US
Mailing Address - Phone:817-240-8273
Mailing Address - Fax:
Practice Address - Street 1:1228 BURMEISTER RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-3705
Practice Address - Country:US
Practice Address - Phone:817-240-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT29432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer