Provider Demographics
NPI:1487267555
Name:THOMAS, DILLON EVERETT
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:EVERETT
Last Name:THOMAS
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 1:4613 CEDARWEED BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1068
Mailing Address - Country:US
Mailing Address - Phone:719-334-5348
Mailing Address - Fax:
Practice Address - Street 1:4613 CEDARWEED BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1068
Practice Address - Country:US
Practice Address - Phone:719-334-5348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist