Provider Demographics
NPI:1871821637
Name:SILLS, DAWN (DAWN SILLS)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SILLS
Suffix:
Gender:F
Credentials:DAWN SILLS
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:DEMEULENAERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:4230 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4763
Mailing Address - Country:US
Mailing Address - Phone:248-475-3404
Mailing Address - Fax:248-475-3404
Practice Address - Street 1:4230 HOLLY LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-4763
Practice Address - Country:US
Practice Address - Phone:248-475-3404
Practice Address - Fax:248-475-3404
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist