Individual
MR. JAMES RANDOLPH TILTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
203 DILTS RD, ITHACA, MI 48847-9475
(989) 875-2266
(989) 875-2225
Mailing address
203 DILTS RD, ITHACA, MI 48847-9475
(989) 875-2266
(989) 875-2225
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501008948
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200770947
TAX ID
—
01
—
607648000
OFFICE OF WORKERS COMP.
MI
01
—
64-70128
PHP
MI
01
—
650B910270
BCBSM AND BCN
MI
01
—
7594704
AETNA
MI
05
—
A2741KD1
—
IL
Enumeration date
07/18/2006
Last updated
02/01/2024
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