Healthcare Provider Details

I. General information

NPI: 1699007658
Provider Name (Legal Business Name): ANDREA MARIE DILLON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SIERRA PARK RD
MAMMOTH LAKES CA
93546-2073
US

IV. Provider business mailing address

PO BOX 660
MAMMOTH LAKES CA
93546-0660
US

V. Phone/Fax

Practice location:
  • Phone: 760-734-7302
  • Fax: 760-934-7302
Mailing address:
  • Phone: 760-934-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-1361
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: