Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2088442 | TX |
NPI | 1013277029 |
---|---|
Provider Name | Timothy T Dillen |
First Address | Las Cruces, NM 88001-3167 |
Second Address | Las Cruces, NM 88001-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2012 |
Last Update Date | 23/05/2012 |