Healthcare Provider Details

I. General information

NPI: 1427972512
Provider Name (Legal Business Name): MAKENNA DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N BROADWAY
BALTIMORE MD
21205-1424
US

IV. Provider business mailing address

8000 DOGWOOD RD TRLR 25
SPARROWS POINT MD
21219-2344
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30993
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: