Provider Demographics
NPI:1295807964
Name:DIXON, CAROL LYNN (MSPT)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:DIXON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:BARTHOLOMEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 712252
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84171
Mailing Address - Country:US
Mailing Address - Phone:801-943-2396
Mailing Address - Fax:
Practice Address - Street 1:1952 E 7000 S
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-942-3311
Practice Address - Fax:801-942-5595
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1155622401225100000X
CAPT27201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTN0615Medicaid