Provider Demographics
NPI:1932127164
Name:DIXON, NICKI (PT)
Entity Type:Individual
Prefix:
First Name:NICKI
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 MAHAN CORNER RD
Mailing Address - Street 2:
Mailing Address - City:MARYDEL
Mailing Address - State:DE
Mailing Address - Zip Code:19964-1831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:642 S QUEEN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3506
Practice Address - Country:US
Practice Address - Phone:302-674-1269
Practice Address - Fax:302-674-1749
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist