Healthcare Provider Details

I. General information

NPI: 1558544809
Provider Name (Legal Business Name): VALERIE JEAN DIXON RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10711 E BIG MEADOWS RD
CHATTAROY WA
99003-9516
US

IV. Provider business mailing address

10711 E BIG MEADOWS RD
CHATTAROY WA
99003-9516
US

V. Phone/Fax

Practice location:
  • Phone: 509-238-4667
  • Fax:
Mailing address:
  • Phone: 509-238-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00003313
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: