Provider Demographics
NPI:1962743807
Name:DIXON, JAIME LYNN (PT, DPT, LAC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:DIXON
Suffix:
Gender:F
Credentials:PT, DPT, LAC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:29 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2156
Mailing Address - Country:US
Mailing Address - Phone:908-276-0294
Mailing Address - Fax:908-276-0753
Practice Address - Street 1:29 ALDEN ST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2156
Practice Address - Country:US
Practice Address - Phone:908-276-0294
Practice Address - Fax:908-276-0753
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01341100225100000X
NJ25MZ00141500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist