Provider Demographics
NPI:1053603191
Name:DAWSON, MICHAEL ADAM (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ADAM
Last Name:DAWSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19260 STONE OAK PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3365
Mailing Address - Country:US
Mailing Address - Phone:210-545-9355
Mailing Address - Fax:210-545-9369
Practice Address - Street 1:19260 STONE OAK PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3365
Practice Address - Country:US
Practice Address - Phone:210-545-9355
Practice Address - Fax:210-545-9369
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist