Provider Demographics
NPI:1497117030
Name:DIXON, TRUDI (LMT, CST)
Entity Type:Individual
Prefix:
First Name:TRUDI
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7047 GERMANTOWN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1866
Mailing Address - Country:US
Mailing Address - Phone:267-422-2254
Mailing Address - Fax:
Practice Address - Street 1:7047 GERMANTOWN AVE STE 205
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1866
Practice Address - Country:US
Practice Address - Phone:267-422-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG008981225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist