Provider Demographics
NPI:1912208240
Name:CHARLES M. DILLA, P.T., P.A.
Entity Type:Organization
Organization Name:CHARLES M. DILLA, P.T., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DILLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-681-6077
Mailing Address - Street 1:11237 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4554
Mailing Address - Country:US
Mailing Address - Phone:301-681-6077
Mailing Address - Fax:301-681-3798
Practice Address - Street 1:11237 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4554
Practice Address - Country:US
Practice Address - Phone:301-681-6077
Practice Address - Fax:301-681-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14012261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy