Provider Demographics
NPI:1497027205
Name:DIXON, SCOTT LANDON (DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LANDON
Last Name:DIXON
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 1:748 OLD NORCROSS RD 150
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3395
Mailing Address - Country:US
Mailing Address - Phone:770-771-5445
Mailing Address - Fax:770-771-5440
Practice Address - Street 1:748 OLD NORCROSS RD 150
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3395
Practice Address - Country:US
Practice Address - Phone:770-771-5445
Practice Address - Fax:770-771-5440
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT101554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist