MEDICARE: HEATHER I DIXON LMT, CPT

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	225700000X	Massage Therapist	MA49528	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0009592107	OTHER		AETNA
2	C6997	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1922202605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER I DIXON LMT, CPT

Provider Business Mailing Address
First Line	:	5012 KENDRICK ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-6702
Country	:	US
Telephone Number	:	850-774-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 W 10TH ST UNIT 101A
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-7404
Country	:	US
Telephone Number	:	850-774-1199
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	09/25/2013

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