Provider Demographics
NPI:1235378647
Name:TILTON, GARY (PTA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:TILTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1604
Mailing Address - Country:US
Mailing Address - Phone:603-466-5972
Mailing Address - Fax:603-466-5974
Practice Address - Street 1:40 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1604
Practice Address - Country:US
Practice Address - Phone:603-466-5972
Practice Address - Fax:603-466-5974
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0255225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant