1184603169 NPI number — MRS. CHRISTINE ALLISON TILBURG PHYSICAL THERAPIST

Table of content: MRS. CHRISTINE ALLISON TILBURG PHYSICAL THERAPIST (NPI 1184603169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184603169 NPI number — MRS. CHRISTINE ALLISON TILBURG PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TILBURG
Provider First Name:
CHRISTINE
Provider Middle Name:
ALLISON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REED
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
ALLISON
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184603169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTOURSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-368-8389
Provider Business Mailing Address Fax Number:
570-368-8391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTOURSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-368-8389
Provider Business Practice Location Address Fax Number:
570-368-8391
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT006167L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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