Healthcare Provider Details

I. General information

NPI: 1932127164
Provider Name (Legal Business Name): NICKI DIXON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 S QUEEN ST SUITE 102
DOVER DE
19904-3506
US

IV. Provider business mailing address

3761 MAHAN CORNER RD
MARYDEL DE
19964-1831
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-1269
  • Fax: 302-674-1749
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: