Provider Demographics
NPI:1154936847
Name:DILLERA, MARICOR (PT)
Entity type:Individual
Prefix:MS
First Name:MARICOR
Middle Name:
Last Name:DILLERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 FROSTBURG WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1452
Mailing Address - Country:US
Mailing Address - Phone:301-383-3019
Mailing Address - Fax:
Practice Address - Street 1:9366 GAITHER RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1416
Practice Address - Country:US
Practice Address - Phone:301-383-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist