Active NPI
Randy W Dillon, MS,ATC,LAT, LMT, PES
- Athletic Trainer
- Prospect Park, PA
National Provider Identifier
1043810021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT003236
- Practice address
- 617C Chester Pike
Prospect Park, PA 19076-1506 - Phone
- (267) 800-8031
- NPI assigned
- Oct 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MSG010353 | PA | |
| Athletic Trainer | 2255A2300X | RT003236 | PA | Primary |
Addresses
Primary practice location
617C Chester Pike
Prospect Park, PA 19076-1506
Mailing address
917 Old Fern Hill Rd Ste 500
West Chester, PA 19380-4255
Phone (267) 800-8031
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT003236 | PA | MD | Athletic Trainer |
| MSG010353 | PA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730073600000",
"number": "1043810021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "917 OLD FERN HILL RD STE 500",
"city": "WEST CHESTER",
"state": "PA",
"postal_code": "193804255",
"telephone_number": "267-800-8031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617C CHESTER PIKE",
"city": "PROSPECT PARK",
"state": "PA",
"postal_code": "190761506",
"telephone_number": "267-800-8031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLON",
"first_name": "RANDY",
"middle_name": "W",
"credential": "MS,ATC,LAT, LMT, PES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-28",
"last_updated": "2024-10-28",
"certification_date": "2024-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "PA",
"license": "MSG010353",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT003236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prospect Park, PA
- Christy Marie Benjamin Lazaroff, D.M.D
- Richard N Benjamin
- Valerie R Bolletino, LCSW
- Chesapeake Medical Supply, Inc (Philadelphia Rehab)
- David Derosa
- Divine Providence Village
- Stephen P Donahue, M.A.
- Margaret M Donnelly, PTA
- E & R Home Care Services of Pennsylvania LLC
- Family Chiropractic Wellness Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.