MEDICARE: MR. WILLIAM CAMERON MC DILL PT

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	PT2170	CA

General Provider Information

NPI Number	:	1962432351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CAMERON MC DILL PT

Provider Business Mailing Address
First Line	:	18 SAN LUIS COURT
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94945
Country	:	US
Telephone Number	:	415-892-7880
Fax Number	:	415-897-2433

Provider Business Practice Location Address
First Line	:	18 SAN LUIS CT
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94945-1713
Country	:	US
Telephone Number	:	415-892-7880
Fax Number	:	415-897-2433

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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