Provider Demographics
NPI:1255911806
Name:NIXON, PAUL ALLEN (LMT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALLEN
Last Name:NIXON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3144
Mailing Address - Country:US
Mailing Address - Phone:512-999-8254
Mailing Address - Fax:
Practice Address - Street 1:8695 SW JACK BURNS BLVD STE E
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5797
Practice Address - Country:US
Practice Address - Phone:503-386-5340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT047430225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist