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General NPI Number Information
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NPI Number | 1912308982
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Entity Type | Organization
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Legal Business Name | COPELAND DIXON PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 525 COURT ST
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City | RENO
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State | NV
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Zip | 89501-1731
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Country | US
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Telephone | 775-560-7699
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Fax |
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Provider Business Mailing Address
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Address Line | 6010 GOLDENROD DR
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City | RENO
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State | NV
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Zip | 89511-8076
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Country | US
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Telephone | 775-560-7699
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Fax |
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | KYLE MATTHEW DIXON
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Credential | DPT
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Telephone | 775-560-7699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1562
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License Number State | NV
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