Provider Demographics
NPI:1336308840
Name:DIXON, BETTY MORGAN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:MORGAN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3415
Mailing Address - Country:US
Mailing Address - Phone:252-443-1720
Mailing Address - Fax:
Practice Address - Street 1:160 S WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3419
Practice Address - Country:US
Practice Address - Phone:252-443-7667
Practice Address - Fax:252-451-8136
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1264225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant