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General NPI Number Information
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NPI Number | 1225321417
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Entity Type | Individual
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Provider Name | JONATHAN ELLIOT DIXON LPTA
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Gender | Male
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 1890 E 107TH ST
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City | CLEVELAND
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State | OH
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Zip | 44106-2235
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Country | US
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Telephone | 216-791-7057
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Fax |
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Provider Business Mailing Address
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Address Line | 1371 CRANEING RD
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City | WICKLIFFE
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State | OH
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Zip | 44092-2519
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Country | US
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Telephone | 440-812-1743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 06649
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License Number State | OH
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