Tilly, Susan
Tilly, Susan is an individual health care provider with primary practice located at 12261 W 159Th St , Homer Glen IL 60491-7847. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic, which is considered as her primary health care specialty. Tilly, Susan can be contacted via phone (708) 301-2255.Contact Information
Primary practice address
12261 W 159Th St
Homer Glen IL 60491-7847
Phone: (708) 301-2255
Fax: (708) 301-2631
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic | 2251X0800X | 070-12455 | Illinois |
Profile Details
| NPI number | 1639253636 |
|---|---|
| LBN Legal business name | Tilly, Susan |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 25th, 2006 |
| Last updated | Jul 12th, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639253636 | NPPES |
| Illinois | Other | 1623066 | BCBS PROVIDER # |
| Illinois | Other | 367885100 | BCBS PROVIDER # |
| Illinois | Other | CJ4383 | BCBS PROVIDER # |
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