Provider Demographics
NPI:1033575527
Name:AYTCH-HENDERSON, TILA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TILA
Middle Name:
Last Name:AYTCH-HENDERSON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 DEEP RIVER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6249
Mailing Address - Country:US
Mailing Address - Phone:562-489-4600
Mailing Address - Fax:
Practice Address - Street 1:1223 DEEP RIVER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6249
Practice Address - Country:US
Practice Address - Phone:562-489-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT62222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer