Provider Demographics
NPI:1992445787
Name:DICKINSON, LILY M (ATC)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:M
Last Name:DICKINSON
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 1:12330 VANCE JACKSON RD APT 15103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-6039
Mailing Address - Country:US
Mailing Address - Phone:916-607-8909
Mailing Address - Fax:
Practice Address - Street 1:12330 VANCE JACKSON RD APT 15103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-6039
Practice Address - Country:US
Practice Address - Phone:916-607-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer