Provider Demographics
NPI:1952687444
Name:TILSON, JULIE KRISTIN (PT, DPT,NCS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:KRISTIN
Last Name:TILSON
Suffix:
Gender:F
Credentials:PT, DPT,NCS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1640 MARENGO ST
Mailing Address - Street 2:HRA-102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1036
Mailing Address - Country:US
Mailing Address - Phone:323-224-7070
Mailing Address - Fax:323-224-7075
Practice Address - Street 1:1640 MARENGO ST
Practice Address - Street 2:HRA-102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1036
Practice Address - Country:US
Practice Address - Phone:323-224-7070
Practice Address - Fax:323-224-7075
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT235652251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT23565OtherPT LICENSE