Active NPI
Justin Brian Dickinson, ATC
- Athletic Trainer
- San Antonio, TX
National Provider Identifier
1497478408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT8564
- Practice address
- 1303 McCullough Ave Ste 600
San Antonio, TX 78212-5608 - Phone
- (210) 508-9217
- NPI assigned
- Sep 23, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT8564 | TX | Primary |
Addresses
Primary practice location
1303 McCullough Ave Ste 600
San Antonio, TX 78212-5608
Mailing address
10415 Beachball Bend
Converse, TX 78109
Phone (480) 205-6426
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT8564 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663891200000",
"number": "1497478408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10415 BEACHBALL BEND",
"city": "CONVERSE",
"state": "TX",
"postal_code": "78109",
"telephone_number": "480-205-6426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1303 MCCULLOUGH AVE STE 600",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782125608",
"telephone_number": "210-508-9217"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKINSON",
"first_name": "JUSTIN",
"middle_name": "BRIAN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-23",
"last_updated": "2022-09-23",
"certification_date": "2022-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT8564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.