Provider Demographics
NPI:1437614039
Name:DIX, MISTY BELL (PT)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:BELL
Last Name:DIX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:RENEE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1409 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-3902
Mailing Address - Country:US
Mailing Address - Phone:803-777-6894
Mailing Address - Fax:803-777-0126
Practice Address - Street 1:1409 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-3902
Practice Address - Country:US
Practice Address - Phone:803-777-6894
Practice Address - Fax:803-777-0126
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist