Provider Demographics
NPI:1972889418
Name:DIXON, COLIN (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2509
Mailing Address - Country:US
Mailing Address - Phone:610-409-3477
Mailing Address - Fax:610-409-3776
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2509
Practice Address - Country:US
Practice Address - Phone:610-409-3477
Practice Address - Fax:610-409-3776
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0045662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer