Provider Demographics
NPI:1053788455
Name:DIX, BRIAN AYERS (PTA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:AYERS
Last Name:DIX
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 WESTSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4077
Mailing Address - Country:US
Mailing Address - Phone:301-646-9713
Mailing Address - Fax:
Practice Address - Street 1:542 WESTSIDE BLVD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4077
Practice Address - Country:US
Practice Address - Phone:301-646-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4068225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant