Provider Demographics
NPI:1780041806
Name:DILLER, ROBERT VINCENT (DHSC, ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VINCENT
Last Name:DILLER
Suffix:
Gender:M
Credentials:DHSC, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6505
Mailing Address - Country:US
Mailing Address - Phone:561-803-2379
Mailing Address - Fax:561-803-2390
Practice Address - Street 1:901 S FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6505
Practice Address - Country:US
Practice Address - Phone:561-803-2379
Practice Address - Fax:561-803-2390
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 43912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer