Provider Demographics
NPI:1780171421
Name:DIXON, WILLIAM HENRY III (LMBT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:DIXON
Suffix:III
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 BRAMBLEGATE RD UNIT J
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-3017
Mailing Address - Country:US
Mailing Address - Phone:336-908-1732
Mailing Address - Fax:
Practice Address - Street 1:1603 BATTLEGROUND AVE STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8050
Practice Address - Country:US
Practice Address - Phone:336-541-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11743OtherLMBT (LICENSED MASSAGE AND BODYWORK THERAPIST)