Provider Demographics
NPI:1376898395
Name:DIXON, GREGORY ANDREW (DPT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ANDREW
Last Name:DIXON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12501 NE BEL RED RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2509
Mailing Address - Country:US
Mailing Address - Phone:425-450-9801
Mailing Address - Fax:425-450-9778
Practice Address - Street 1:12501 NE BEL RED RD STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2509
Practice Address - Country:US
Practice Address - Phone:425-450-9801
Practice Address - Fax:425-450-9778
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035228225100000X
WA60476013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist