Provider Demographics
NPI:1669105003
Name:MCKITTRICK, DEION TERELL (ATC)
Entity type:Individual
Prefix:
First Name:DEION
Middle Name:TERELL
Last Name:MCKITTRICK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 BREANNA WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5828
Mailing Address - Country:US
Mailing Address - Phone:918-409-8334
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE STE 5000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1792
Practice Address - Country:US
Practice Address - Phone:214-818-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000518992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer