Provider Demographics
NPI:1295253086
Name:GREGORY, DILLON ROBERT (ATC)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:ROBERT
Last Name:GREGORY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 N ROADRUNNER PKWY APT 2402
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8132
Mailing Address - Country:US
Mailing Address - Phone:843-323-8196
Mailing Address - Fax:
Practice Address - Street 1:1815 WELLS ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-1304
Practice Address - Country:US
Practice Address - Phone:843-323-8196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMAT8152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program