Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | IL | |
N | 2251G0304X | Physical Therapist - Geriatrics | IL |
NPI | 1407028863 |
---|---|
Provider Name | Ms. Christine Marie Dillon |
First Address | Champaign, IL 61820 |
Second Address | Champaign, IL 61820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2008 |
Last Update Date | 26/03/2008 |