Healthcare Provider Details

I. General information

NPI: 1952687444
Provider Name (Legal Business Name): JULIE KRISTIN TILSON PT, DPT,NCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 MARENGO ST HRA-102
LOS ANGELES CA
90033-1036
US

IV. Provider business mailing address

1640 MARENGO ST HRA-102
LOS ANGELES CA
90033-1036
US

V. Phone/Fax

Practice location:
  • Phone: 323-224-7070
  • Fax: 323-224-7075
Mailing address:
  • Phone: 323-224-7070
  • Fax: 323-224-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT23565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: