Provider Demographics
NPI:1891550174
Name:DIX, TIM (DPT)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:DIX
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 1:112 PINE ST APT 3P
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8435
Mailing Address - Country:US
Mailing Address - Phone:609-937-9805
Mailing Address - Fax:
Practice Address - Street 1:120 GRAHAM WAY STE 110
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7217
Practice Address - Country:US
Practice Address - Phone:802-985-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist