Provider Demographics
NPI:1376866244
Name:TILSON, BAYLA (PT)
Entity Type:Individual
Prefix:
First Name:BAYLA
Middle Name:
Last Name:TILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14-23 RIVER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1240
Mailing Address - Country:US
Mailing Address - Phone:201-703-0600
Mailing Address - Fax:
Practice Address - Street 1:14-23 RIVER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1240
Practice Address - Country:US
Practice Address - Phone:201-703-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00183500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist