Provider Demographics
NPI:1366937401
Name:PRATT, DOMINIQUE LAMAR (ATC)
Entity type:Individual
Prefix:MR
First Name:DOMINIQUE
Middle Name:LAMAR
Last Name:PRATT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:MR
Other - First Name:DOMINIQUE
Other - Middle Name:LAMAR
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:4617 SW I AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7829
Mailing Address - Country:US
Mailing Address - Phone:580-647-5597
Mailing Address - Fax:
Practice Address - Street 1:4617 SW I AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7829
Practice Address - Country:US
Practice Address - Phone:580-647-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer