Healthcare Provider Details

I. General information

NPI: 1851219125
Provider Name (Legal Business Name): DYLAN MCNEILL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 UNIVERSITY PARK
STATE COLLEGE PA
16802
US

IV. Provider business mailing address

1791 NASHVILLE LN
CRYSTAL LAKE IL
60014-2916
US

V. Phone/Fax

Practice location:
  • Phone: 814-863-1864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: