Healthcare Provider Details

I. General information

NPI: 1275134470
Provider Name (Legal Business Name): CLAYTON DIXON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 HIGHWAY 17 N
NORTH MYRTLE BEACH SC
29582-2229
US

IV. Provider business mailing address

210 VILLAGE CENTER BLVD STE 140
MYRTLE BEACH SC
29579-6706
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax:
Mailing address:
  • Phone: 843-353-3460
  • Fax: 843-353-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10606
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: