Provider Demographics
NPI:1427648633
Name:WILLS, DYLAN J (DPT)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:J
Last Name:WILLS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68059-4725
Mailing Address - Country:US
Mailing Address - Phone:402-672-0855
Mailing Address - Fax:
Practice Address - Street 1:9006 OHIO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6139
Practice Address - Country:US
Practice Address - Phone:402-391-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist