Healthcare Provider Details

I. General information

NPI: 1649768029
Provider Name (Legal Business Name): DEVIN HILLMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MEDICAL DR
GAINESVILLE MO
65655-8133
US

IV. Provider business mailing address

850 S EASTLAND AVE
SPRINGFIELD MO
65802-4899
US

V. Phone/Fax

Practice location:
  • Phone: 417-679-4921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2016027276
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: