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NPI Code Detail

MEDICARE: MR. ADRIAN TERRELL DIXON PT, ATC

MEDICARE: MR. ADRIAN TERRELL DIXON PT, ATC
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
12255A2300XAthletic TrainerAL2608FL

General Provider Information

NPI Number : 1912344391
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ADRIAN TERRELL DIXON PT, ATC
Provider Business Mailing Address
First Line : 1 BUCCANEER PL
Second Line :
City : TAMPA
State : FL
Zip : 33607-5701
Country : US
Telephone Number : 850-212-6483
Fax Number :
Provider Business Practice Location Address
First Line : 1 BUCCANEER PL
Second Line :
City : TAMPA
State : FL
Zip : 33607-5701
Country : US
Telephone Number : 850-212-6483
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2013
Last Update Date : 03/31/2014

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