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NPI Code Detail

MEDICARE: MR. DONALD PAUL TILLSON ATC

MEDICARE:  MR. DONALD PAUL TILLSON  ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer0126000002VA

General Provider Information

NPI Number : 1255602710
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD PAUL TILLSON ATC
Provider Business Mailing Address
First Line : 6600 LITTLE FALLS RD
Second Line :
City : ARLINGTON
State : VA
Zip : 22213-1211
Country : US
Telephone Number : 703-237-1456
Fax Number : 703-237-1401
Provider Business Practice Location Address
First Line : 6600 LITTLE FALLS RD
Second Line :
City : ARLINGTON
State : VA
Zip : 22213-1211
Country : US
Telephone Number : 703-237-1456
Fax Number : 703-237-1401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2012
Last Update Date : 01/15/2012

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Directions to “ MR. DONALD PAUL TILLSON ATC” Practice Location

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