Provider Demographics
NPI:1588334197
Name:ELLIOTT, DAKOTA RILEY (LAT, ATC)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:RILEY
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ROAD 2442
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MS
Mailing Address - Zip Code:39365-4010
Mailing Address - Country:US
Mailing Address - Phone:601-575-2025
Mailing Address - Fax:
Practice Address - Street 1:10100 ROAD 2442
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365-4010
Practice Address - Country:US
Practice Address - Phone:601-575-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT84572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer