Healthcare Provider Details

I. General information

NPI: 1952236564
Provider Name (Legal Business Name): MADISON RILEY DILLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W HILL RD APT 1
RHINELANDER WI
54501-2992
US

IV. Provider business mailing address

111 N SEYMOUR ST
FOND DU LAC WI
54935-3151
US

V. Phone/Fax

Practice location:
  • Phone: 920-948-1622
  • Fax:
Mailing address:
  • Phone: 920-948-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1783024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: