Individual
MR. MICHAEL TILLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4350 CONSTELLATION RD, LOMPOC, CA 93436-1033
(805) 742-2900
(895) 742-2917
Mailing address
4350 CONSTELLATION RD, LOMPOC, CA 93436-1099
(805) 742-2900
(805) 742-2917
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
070402516
CA
Other
Enumeration date
03/04/2019
Last updated
03/04/2019
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