Provider Demographics
NPI:1851919997
Name:MATHERS, DYLAN JILL (ATC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JILL
Last Name:MATHERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 WAYMARKET DR APT 617
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6622
Mailing Address - Country:US
Mailing Address - Phone:402-875-0519
Mailing Address - Fax:
Practice Address - Street 1:1200 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2203
Practice Address - Country:US
Practice Address - Phone:402-875-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer