Provider Demographics
NPI:1386197143
Name:DIX, MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DIX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 BUFFALO RD
Mailing Address - Street 2:BLDG 300A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1369
Mailing Address - Country:US
Mailing Address - Phone:845-264-4957
Mailing Address - Fax:
Practice Address - Street 1:401 PENBROOKE DR
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2041
Practice Address - Country:US
Practice Address - Phone:585-377-9626
Practice Address - Fax:585-377-7513
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist