Provider Demographics
NPI:1821567470
Name:DIXON, KATIE E (DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:E
Last Name:DIXON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6149 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4448
Mailing Address - Country:US
Mailing Address - Phone:156-082-5928
Mailing Address - Fax:815-339-0329
Practice Address - Street 1:4227 MARAY DR STE 3
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4977
Practice Address - Country:US
Practice Address - Phone:815-608-2592
Practice Address - Fax:815-339-0329
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist