Provider Demographics
NPI:1164711156
Name:DILLON, RUSSELL KING (PT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:KING
Last Name:DILLON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 N APPLEGATE RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-9443
Mailing Address - Country:US
Mailing Address - Phone:541-862-2189
Mailing Address - Fax:
Practice Address - Street 1:7315 N APPLEGATE RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-9443
Practice Address - Country:US
Practice Address - Phone:541-862-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2641225100000X
CA10234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist