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1508189564

NPI Code Detail

MEDICARE: SHELLY DILLON

MEDICARE: SHELLY DILLON

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	225100000X	Physical Therapist	J10001481	DE
2	225100000X	Physical Therapist	P7500	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G00716	OTHER		FACILITY MEDICARE NUMBER

General Provider Information

NPI Number	:	1508189564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY DILLON

Provider Business Mailing Address
First Line	:	3901 WRIGHTSVILLE AVE STE 120
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6256
Country	:	US
Telephone Number	:	910-679-8385
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 WRIGHTSVILLE AVE STE 120
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6256
Country	:	US
Telephone Number	:	910-679-8385
Fax Number	:

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

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	01/16/2020

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Directions to “ SHELLY DILLON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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