Provider Demographics
NPI:1841371374
Name:ANTHONY, DAWN YVONNE (ATC)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:YVONNE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 STANFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-2816
Mailing Address - Country:US
Mailing Address - Phone:724-859-2536
Mailing Address - Fax:
Practice Address - Street 1:748 STANFIELD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-2816
Practice Address - Country:US
Practice Address - Phone:724-859-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0037192255A2300X
NC15002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1500OtherNC LICENSE
PA020502121OtherNATA CERTIFICATION NUMBER
PART003719OtherPA STATE LICENSE NUMBER