Provider Demographics
NPI:1700546140
Name:TILLMAN, CASSANDRA L (PT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:TILLMAN
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 1:2077 STANTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-7921
Mailing Address - Country:US
Mailing Address - Phone:641-414-4788
Mailing Address - Fax:
Practice Address - Street 1:2077 STANTON HILL RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-7921
Practice Address - Country:US
Practice Address - Phone:641-414-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20882208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation