Provider Demographics
NPI:1265478606
Name:DILLON, MICHAEL (MSPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DILLON
Suffix:
Gender:
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 E STREET RD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7711
Practice Address - Country:US
Practice Address - Phone:267-989-2278
Practice Address - Fax:215-322-7858
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013796L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0824304000OtherAMERIHEALTH
PA914957OtherPA BS PROVIDER ID
914957OtherPABS
P00654891Medicare PIN
PA072091VKFMedicare PIN
914957OtherPABS