MEDICARE: PETER THOMAS DILLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6524	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01417734	OTHER	OR	RR MEDICARE PTAN
3	P01106221	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679867907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER THOMAS DILLS

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD
Second Line	:	SUITE 300
City	:	TIGARD
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:	503-443-6156
Fax Number	:	503-639-9699

Provider Business Practice Location Address
First Line	:	1307 NE 102ND AVE
Second Line	:	SUITE G
City	:	PORTLAND
State	:	OR
Zip	:	97220-3980
Country	:	US
Telephone Number	:	503-253-0924
Fax Number	:	503-256-5469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2011
Last Update Date	:	03/23/2015

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Directions to “ PETER THOMAS DILLS ” Practice Location

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