Provider Demographics
NPI:1124534151
Name:TRILY, TAMARA LILA (DPT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LILA
Last Name:TRILY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LILA
Other - Last Name:PESSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1488 PIONEER WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1633
Mailing Address - Country:US
Mailing Address - Phone:858-755-5200
Mailing Address - Fax:619-343-3514
Practice Address - Street 1:760 13TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-2308
Practice Address - Country:US
Practice Address - Phone:858-755-5200
Practice Address - Fax:619-941-2681
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
CA294448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic