Provider Demographics
NPI:1093092454
Name:HILLIS, JOHN DUANE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DUANE
Last Name:HILLIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STUYVESANT OVAL
Mailing Address - Street 2:APARTMENT 3-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2020
Mailing Address - Country:US
Mailing Address - Phone:212-460-5938
Mailing Address - Fax:
Practice Address - Street 1:19 STUYVESANT OVAL
Practice Address - Street 2:APARTMENT 3-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2020
Practice Address - Country:US
Practice Address - Phone:212-460-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist