Provider Demographics
NPI:1205916848
Name:HILLMAN, DAVID WATSON (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WATSON
Last Name:HILLMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6045
Mailing Address - Country:US
Mailing Address - Phone:208-777-7800
Mailing Address - Fax:208-777-9209
Practice Address - Street 1:1132 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6045
Practice Address - Country:US
Practice Address - Phone:208-777-7800
Practice Address - Fax:208-777-9209
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT912174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010024489OtherREGENCE BLUE SHIELD
IDGROUP HEALTHOther7624
IDT2516OtherBLUE CROSS
ID650011684OtherRAILROAD MEDICARE
ID1134149941Medicaid
WA101976OtherWASHINGTON L&I