Provider Demographics
NPI:1225321417
Name:DIXON, JONATHAN ELLIOT (LPTA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ELLIOT
Last Name:DIXON
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 CRANEING RD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2519
Mailing Address - Country:US
Mailing Address - Phone:440-812-1743
Mailing Address - Fax:
Practice Address - Street 1:1890 E 107TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2235
Practice Address - Country:US
Practice Address - Phone:216-791-7057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 06649225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant