MEDICARE: KENESHA ANN-MARIE DIXON III M.S.P.T

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	174400000X	Specialist	23365	FL

General Provider Information

NPI Number	:	1437342573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENESHA ANN-MARIE DIXON III M.S.P.T

Provider Business Mailing Address
First Line	:	17401 SW 142ND CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-2784
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 N STATE ROAD 7 STE A
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-5184
Country	:	US
Telephone Number	:	561-784-3767
Fax Number	:

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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