Provider Demographics
NPI:1285194704
Name:TILBURY, SHEENA
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:TILBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 COUNTY ROAD 245
Mailing Address - Street 2:
Mailing Address - City:BECKVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75631-4614
Mailing Address - Country:US
Mailing Address - Phone:903-806-7663
Mailing Address - Fax:
Practice Address - Street 1:416 COUNTY ROAD 245
Practice Address - Street 2:
Practice Address - City:BECKVILLE
Practice Address - State:TX
Practice Address - Zip Code:75631-4614
Practice Address - Country:US
Practice Address - Phone:903-806-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2126096225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant