Individual
TIMOTHY J TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3742
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275285
—
OR
01
—
825811000
BLUECROSS BLUESHIELD
OR
Enumeration date
10/16/2006
Last updated
08/19/2008
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