Provider Demographics
NPI:1114274909
Name:DIXON, TRISTA (DPT)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-1724
Mailing Address - Country:US
Mailing Address - Phone:717-334-6834
Mailing Address - Fax:717-334-3923
Practice Address - Street 1:10 SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-1724
Practice Address - Country:US
Practice Address - Phone:717-334-6834
Practice Address - Fax:717-334-3923
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207567225100000X
PAPT023514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist