Provider Demographics
NPI:1659939239
Name:FOSS, DILLAN (ATC)
Entity Type:Individual
Prefix:
First Name:DILLAN
Middle Name:
Last Name:FOSS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 NE 22ND AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5242
Mailing Address - Country:US
Mailing Address - Phone:401-595-1137
Mailing Address - Fax:
Practice Address - Street 1:32 NE 22ND AVE APT 104
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5242
Practice Address - Country:US
Practice Address - Phone:401-595-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer