Provider Demographics
NPI:1922202605
Name:DIXON, HEATHER I (LMT, CPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:I
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 KENDRICK ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6702
Mailing Address - Country:US
Mailing Address - Phone:850-774-1199
Mailing Address - Fax:
Practice Address - Street 1:3001 W 10TH ST UNIT 101A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-7404
Practice Address - Country:US
Practice Address - Phone:850-774-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49528225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0009592107OtherAETNA
FLC6997OtherBLUE CROSS BLUE SHIELD