Provider Demographics
NPI:1508977190
Name:TILFORD, ANDREW LAWRENCE (MSPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LAWRENCE
Last Name:TILFORD
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 NORVELL RD
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9764
Mailing Address - Country:US
Mailing Address - Phone:517-536-4131
Mailing Address - Fax:
Practice Address - Street 1:124 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-8588
Practice Address - Country:US
Practice Address - Phone:517-592-8695
Practice Address - Fax:517-592-5081
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist