Provider Demographics
NPI:1124408109
Name:BIASELLA, DILLON TERREL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:TERREL
Last Name:BIASELLA
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 1:6932 W MARY JANE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4539
Mailing Address - Country:US
Mailing Address - Phone:951-970-2611
Mailing Address - Fax:
Practice Address - Street 1:6932 W MARY JANE LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-4539
Practice Address - Country:US
Practice Address - Phone:951-970-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist