Provider Demographics
NPI:1063971034
Name:BILLINGS, DYLAN KEITH
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:KEITH
Last Name:BILLINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 SUNDANCE RD
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330-8010
Mailing Address - Country:US
Mailing Address - Phone:484-542-3125
Mailing Address - Fax:
Practice Address - Street 1:505 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7916
Practice Address - Country:US
Practice Address - Phone:570-420-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant