Provider Demographics
NPI:1104198142
Name:ADVANCED ORTHOPEDICS & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-378-3930
Mailing Address - Street 1:1325 WEATHERVANE LN
Mailing Address - Street 2:APT 3C
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7958
Mailing Address - Country:US
Mailing Address - Phone:216-906-9156
Mailing Address - Fax:
Practice Address - Street 1:4670 RICHMOND RD
Practice Address - Street 2:SUITE 250
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-6410
Practice Address - Country:US
Practice Address - Phone:216-378-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization