Provider Demographics
NPI:1144293820
Name:DILL, WILLIAM EDWARD II (EDD, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:DILL
Suffix:II
Gender:M
Credentials:EDD, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 LANDING PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4071
Mailing Address - Country:US
Mailing Address - Phone:636-299-0049
Mailing Address - Fax:
Practice Address - Street 1:1925 S ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-2879
Practice Address - Country:US
Practice Address - Phone:636-299-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0017562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer