Provider Demographics
NPI:1366950321
Name:DIXON, CORA YVONNE (LMT)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:YVONNE
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 COVE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-5003
Mailing Address - Country:US
Mailing Address - Phone:469-607-9952
Mailing Address - Fax:
Practice Address - Street 1:641 COVE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-5003
Practice Address - Country:US
Practice Address - Phone:469-607-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT106223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist