Provider Demographics
NPI:1356568018
Name:DIXON, ROSAMOND E (PT)
Entity type:Individual
Prefix:MRS
First Name:ROSAMOND
Middle Name:E
Last Name:DIXON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ROSAMOND
Other - Middle Name:E
Other - Last Name:ROGERS-WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1215 CERRILLOS RD SW
Mailing Address - Street 2:CARLOS REY ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8016
Mailing Address - Country:US
Mailing Address - Phone:505-836-7738
Mailing Address - Fax:
Practice Address - Street 1:1215 CERRILLOS RD SW
Practice Address - Street 2:CARLOS REY ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-8016
Practice Address - Country:US
Practice Address - Phone:505-836-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71448Medicaid