1952687444 NPI number — DR. JULIE KRISTIN TILSON PT, DPT,NCS

Table of content: DR. JULIE KRISTIN TILSON PT, DPT,NCS (NPI 1952687444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952687444 NPI number — DR. JULIE KRISTIN TILSON PT, DPT,NCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TILSON
Provider First Name:
JULIE
Provider Middle Name:
KRISTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT,NCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952687444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 MARENGO ST
Provider Second Line Business Mailing Address:
HRA-102
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90033-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-224-7070
Provider Business Mailing Address Fax Number:
323-224-7075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 MARENGO ST
Provider Second Line Business Practice Location Address:
HRA-102
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-224-7070
Provider Business Practice Location Address Fax Number:
323-224-7075
Provider Enumeration Date:
10/27/2011

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: 2251N0400X , with the licence number:  PT23565 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PT23565 . This is a "PT LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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