=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235734641
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TENASIA DIXON LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2020
-----------------------------------------------------
Last Update Date | 12/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8750 E MCDOWELL RD APT 34
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85257-3924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 152-034-0966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8750 E MCDOWELL RD APT 34
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85257-3924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 152-034-0966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT24949
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------