Provider Demographics
NPI:1033877097
Name:OLIVIERI, DILLON MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:MICHAEL
Last Name:OLIVIERI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GEORGE KARL BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7183
Mailing Address - Country:US
Mailing Address - Phone:716-539-0888
Mailing Address - Fax:716-539-0889
Practice Address - Street 1:40 GEORGE KARL BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7183
Practice Address - Country:US
Practice Address - Phone:716-539-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist