Organization
TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC
Active
Other names
Tillman Physical Therapy & Sports Training Center, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RAY TILLMAN MPT, CSCS, CERT. MDT (PHYICAL THERAPIST PRESIDENT)
(512) 331-6200
Entity
Organization
Contact information
Practice address
2519 S LAKELINE BLVD, SUITE 100, CEDAR PARK, TX 78613-2964
(512) 331-6200
(512) 331-4312
Mailing address
2519 S LAKELINE BLVD, SUITE 100, CEDAR PARK, TX 78613-2964
(512) 331-6200
(512) 331-6384
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
554280000
TX
261QP2000X
Physical Therapy Clinic/Center
Primary
644350000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153870401
—
TX
Enumeration date
06/25/2006
Last updated
03/17/2011
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