MEDICARE: BENJAMIN DIXON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9255	CO

General Provider Information

NPI Number	:	1396060463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN DIXON DPT

Provider Business Mailing Address
First Line	:	3316 SHERIDAN AVE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2649
Country	:	US
Telephone Number	:	303-746-7749
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 W DRAKE RD
Second Line	:	BLDG E SUITE A
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5556
Country	:	US
Telephone Number	:	970-416-8342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	04/01/2010

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