Healthcare Provider Details

I. General information

NPI: 1992566996
Provider Name (Legal Business Name): LAUREN MICHELLE DILLON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EARHART RD
ANN ARBOR MI
48105-2768
US

IV. Provider business mailing address

4786 WASHTENAW AVE APT A1
ANN ARBOR MI
48108-1429
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-6410
  • Fax:
Mailing address:
  • Phone: 989-670-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502008337
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: