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NPI Code Detail

MEDICARE: MIKE DIXEY PT

MEDICARE:   MIKE  DIXEY  PT
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
1225100000XPhysical Therapist6119MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2176P7DIOTHERMNBC INDIV PROV ID
36405738OTHERFMMEDICA INDIV PROV ID

General Provider Information

NPI Number : 1902860216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKE DIXEY PT
Provider Business Mailing Address
First Line : 4200 DAHLBERG DR STE 300
Second Line :
City : GOLDEN VALLEY
State : MN
Zip : 55422-4841
Country : US
Telephone Number : 952-520-7870
Fax Number : 952-520-7580
Provider Business Practice Location Address
First Line : 4010 W 65TH ST
Second Line :
City : EDINA
State : MN
Zip : 55435-1706
Country : US
Telephone Number : 952-456-7000
Fax Number : 952-456-7001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 11/09/2017

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