Provider Demographics
NPI:1417400680
Name:DIX, KRISTINA (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:DIX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:100 BECKS WOODS DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3835
Practice Address - Country:US
Practice Address - Phone:302-392-3400
Practice Address - Fax:302-392-3401
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist