Provider Demographics
NPI:1750928370
Name:TORKELSON, PHIL TYLER
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:TYLER
Last Name:TORKELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 ROYALTON CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0702
Mailing Address - Country:US
Mailing Address - Phone:209-556-2544
Mailing Address - Fax:
Practice Address - Street 1:1674 FULKERTH RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-6885
Practice Address - Country:US
Practice Address - Phone:209-556-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician