Healthcare Provider Details

I. General information

NPI: 1952326753
Provider Name (Legal Business Name): JAMES RANDOLPH TILTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 DILTS RD
ITHACA MI
48847-9475
US

IV. Provider business mailing address

875 E HARRISON RD
ALMA MI
48801-9343
US

V. Phone/Fax

Practice location:
  • Phone: 989-875-2266
  • Fax: 989-875-2225
Mailing address:
  • Phone: 989-463-1590
  • Fax: 989-875-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES RANDOLPH TILTON JR.
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: P.T.
Phone: 989-875-2266