Healthcare Provider Details

I. General information

NPI: 1538956644
Provider Name (Legal Business Name): JULIAN DIXON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 W VIENNA RD
CLIO MI
48420-9454
US

IV. Provider business mailing address

4466 W BRISTOL RD
FLINT MI
48507-3170
US

V. Phone/Fax

Practice location:
  • Phone: 810-564-2400
  • Fax: 833-764-5204
Mailing address:
  • Phone: 810-733-1200
  • Fax: 833-764-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020738
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501303879
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1406658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: