Provider Demographics
NPI:1740468123
Name:TILLETT, MONICA LORRAINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LORRAINE
Last Name:TILLETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LORRAINE
Other - Last Name:TILLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:4822 TOWER RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5824
Mailing Address - Country:US
Mailing Address - Phone:336-608-8399
Mailing Address - Fax:336-291-8784
Practice Address - Street 1:4822 TOWER RD UNIT C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5824
Practice Address - Country:US
Practice Address - Phone:336-608-8399
Practice Address - Fax:336-291-8784
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist