Provider Demographics
NPI:1912308982
Name:COPELAND DIXON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COPELAND DIXON PHYSICAL THERAPY
Other - Org Name:PREVAIL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:775-560-7699
Mailing Address - Street 1:6010 GOLDENROD DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8076
Mailing Address - Country:US
Mailing Address - Phone:775-560-7699
Mailing Address - Fax:
Practice Address - Street 1:525 COURT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1731
Practice Address - Country:US
Practice Address - Phone:775-560-7699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1562261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy