Individual
JORDAN TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
310 EMERALD DR, COLUMBUS, MS 39702-5526
(662) 315-4174
Mailing address
5622 COUNTY ROAD 30, ETHELSVILLE, AL 35461-3301
(662) 315-4174
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA5157
MS
Other
Enumeration date
03/14/2016
Last updated
03/14/2016
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