Basic Information
| Provider Information | |||||||||
| NPI: | 1790820793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIXON | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | JOHNSON | ||||||||
| OtherFirstName: | SARAH | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1313 ASHLEY RIVER ROAD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294075315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437663888 | ||||||||
| FaxNumber: | 8437663478 | ||||||||
| Practice Location | |||||||||
| Address1: | 4015 2ND AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294867882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0392974088 | ||||||||
| FaxNumber: | 8887110441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 10/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2276 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.