Provider Demographics
NPI:1720193345
Name:DILL, KENNETH SCOTT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:SCOTT
Last Name:DILL
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 NORTH BANCROFT PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2690
Mailing Address - Country:US
Mailing Address - Phone:302-655-8989
Mailing Address - Fax:302-285-9283
Practice Address - Street 1:1010 N BANCROFT PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2690
Practice Address - Country:US
Practice Address - Phone:302-655-8989
Practice Address - Fax:302-655-9283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00716Medicare Oscar/Certification
DE117006Medicare PIN