Provider Demographics
NPI:1427591932
Name:DIXON, SYDNEY LANNAE (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LANNAE
Last Name:DIXON
Suffix:
Gender:F
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 1:136 MEADOW WOOD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-1677
Mailing Address - Country:US
Mailing Address - Phone:334-224-7379
Mailing Address - Fax:
Practice Address - Street 1:610 LURLEEN B WALLACE BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1713
Practice Address - Country:US
Practice Address - Phone:205-409-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20872255A2300X
ALPHT10606225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer