Provider Demographics
NPI:1861498057
Name:DILLON, JOAN FRANCES (PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:FRANCES
Last Name:DILLON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:FRANCES
Other - Last Name:MESERVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:765 COLEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2403
Mailing Address - Country:US
Mailing Address - Phone:650-326-1807
Mailing Address - Fax:
Practice Address - Street 1:765 COLEMAN AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2403
Practice Address - Country:US
Practice Address - Phone:650-326-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA043624213OtherFEDERAL TAX ID
CAOPT149820Medicare ID - Type UnspecifiedPROVIDER NUMBER
CA043624213OtherFEDERAL TAX ID