MEDICARE: MRS. MICHELLE A. DILLON P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT001635	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6214	OTHER	KY	CHA HEALTH
2	000000049626	OTHER	KY	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194723700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE A. DILLON P.T.

Provider Business Mailing Address
First Line	:	497 TUCKER DR
Second Line	:
City	:	MAYSVILLE
State	:	KY
Zip	:	41056-9111
Country	:	US
Telephone Number	:	606-759-4678
Fax Number	:	606-759-4834

Provider Business Practice Location Address
First Line	:	497 TUCKER DR
Second Line	:
City	:	MAYSVILLE
State	:	KY
Zip	:	41056-9111
Country	:	US
Telephone Number	:	606-759-4678
Fax Number	:	606-759-4834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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