Individual
SUSAN TILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
12261 W 159TH ST, HOMER GLEN, IL 60491-7847
(708) 301-2255
(708) 301-2631
Mailing address
12261 W 159TH ST, HOMER GLEN, IL 60491-7847
(708) 301-2255
(708) 301-2631
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
070-12455
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1623066
BCBS PROVIDER #
IL
01
—
367885100
U.S. DEPT. OF LABOR PROV
IL
01
—
CJ4383
R.R. MEDICARE GROUP #
IL
Enumeration date
10/25/2006
Last updated
07/12/2016
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