Provider Demographics
NPI:1992739387
Name:DICKS, ROB ANTONIO SR (MA, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:ROB
Middle Name:ANTONIO
Last Name:DICKS
Suffix:SR
Gender:M
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2999
Mailing Address - Country:US
Mailing Address - Phone:706-880-8099
Mailing Address - Fax:
Practice Address - Street 1:601 BROAD ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2955
Practice Address - Country:US
Practice Address - Phone:706-880-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0009192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer