Provider Demographics
NPI:1427017631
Name:DIXON, KYLE M (DPT ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:M
Last Name:DIXON
Suffix:
Gender:M
Credentials:DPT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 GOLDENROD DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8076
Mailing Address - Country:US
Mailing Address - Phone:775-560-7699
Mailing Address - Fax:
Practice Address - Street 1:525 COURT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1731
Practice Address - Country:US
Practice Address - Phone:775-560-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV1562225100000X
NV1562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502293Medicaid
NV100502293Medicaid