MEDICARE: BERNITA DIXON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	19054 PTA9009	AL

General Provider Information

NPI Number	:	1568610236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNITA DIXON

Provider Business Mailing Address
First Line	:	1551 APEX DR
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36693-4910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 DAUPHIN ST
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-1725
Country	:	US
Telephone Number	:	251-621-4466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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Directions to “ BERNITA DIXON ” Practice Location

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