Provider Demographics
NPI:1700802345
Name:DIDIER, DAWN ALLYSON (ATC, LAT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:ALLYSON
Last Name:DIDIER
Suffix:
Gender:F
Credentials: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:PO BOX 7777
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-7777
Mailing Address - Country:US
Mailing Address - Phone:479-575-7584
Mailing Address - Fax:479-575-2946
Practice Address - Street 1:UNIVERSITY OF ARKANSAS
Practice Address - Street 2:BROYLES ATHLETIC CENTER
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-1201
Practice Address - Country:US
Practice Address - Phone:479-575-7584
Practice Address - Fax:479-575-2946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 2682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer