Provider Demographics
NPI:1083823223
Name:DIZON, RIC JAYSON (PT)
Entity Type:Individual
Prefix:MR
First Name:RIC
Middle Name:JAYSON
Last Name:DIZON
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 1:513 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1777
Mailing Address - Country:US
Mailing Address - Phone:856-327-0995
Mailing Address - Fax:856-327-0995
Practice Address - Street 1:1045 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5838
Practice Address - Country:US
Practice Address - Phone:856-405-2530
Practice Address - Fax:856-696-5770
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00853300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist