Provider Demographics
NPI:1861606832
Name:DIX, ALETHEA R (MPT)
Entity type:Individual
Prefix:
First Name:ALETHEA
Middle Name:R
Last Name:DIX
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 PIPESTONE PL
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8623
Mailing Address - Country:US
Mailing Address - Phone:404-431-0510
Mailing Address - Fax:
Practice Address - Street 1:4415 PIPESTONE PL
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8623
Practice Address - Country:US
Practice Address - Phone:404-431-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
007543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist