Provider Demographics
NPI:1457505349
Name:TILLEMANS, CAROL WHITE (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:WHITE
Last Name:TILLEMANS
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 1:4217 VINCENT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1520
Mailing Address - Country:US
Mailing Address - Phone:612-455-0304
Mailing Address - Fax:
Practice Address - Street 1:4217 VINCENT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1520
Practice Address - Country:US
Practice Address - Phone:612-455-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist