Provider Demographics
NPI:1053179705
Name:CORWIN, DILLON (DPT)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:CORWIN
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 1:338 PARK VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869
Mailing Address - Country:US
Mailing Address - Phone:608-718-8069
Mailing Address - Fax:
Practice Address - Street 1:503 US HIGHWAY 202 UNIT 3
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1575
Practice Address - Country:US
Practice Address - Phone:908-800-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02243100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist