Provider Demographics
NPI:1699256073
Name:DYSON, MICHIEL CORD (PT)
Entity type:Individual
Prefix:MR
First Name:MICHIEL
Middle Name:CORD
Last Name:DYSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-2007
Mailing Address - Country:US
Mailing Address - Phone:254-979-2856
Mailing Address - Fax:
Practice Address - Street 1:2400 W BROWN ST
Practice Address - Street 2:
Practice Address - City:SAN SABA
Practice Address - State:TX
Practice Address - Zip Code:76877-3863
Practice Address - Country:US
Practice Address - Phone:325-455-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1190098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist