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General NPI Number Information
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NPI Number | 1043818081
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Entity Type | Individual
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Provider Name | SEAN A TILLERY PT
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Gender | Male
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | N2930 STATE ROAD 22
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City | WAUTOMA
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State | WI
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Zip | 54982-5267
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Country | US
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Telephone | 920-787-5030
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Fax | 920-787-5372
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Provider Business Mailing Address
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Address Line | 3 NEENAH CTR
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City | NEENAH
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State | WI
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Zip | 54956-3070
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Country | US
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Telephone | 920-830-5900
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Fax | 920-830-5910
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-5076
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16686
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License Number State | WI
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