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Individual

CHARLES O TILLMAN III

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
1201 HERITAGE CIR, PAWNEE, OK 74058-3744
(918) 762-6653
(918) 762-6656
Mailing address
5017 E LAKEVIEW RD, STILLWATER, OK 74075-3022
(405) 624-2712

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3469
OK

Other

Enumeration date
12/07/2005
Last updated
07/08/2007
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