Provider Demographics
NPI:1316474984
Name:EVANS, DILLION FORD (DPT, CSCS)
Entity type:Individual
Prefix:MR
First Name:DILLION
Middle Name:FORD
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 DIBERVILLE BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-2419
Mailing Address - Country:US
Mailing Address - Phone:228-280-8120
Mailing Address - Fax:
Practice Address - Street 1:10470 DIBERVILLE BLVD STE H
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2419
Practice Address - Country:US
Practice Address - Phone:228-280-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6142208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation