Active NPI
India D Tilley, PTA
- Physical Therapy Assistant
- Charlotte, NC
National Provider Identifier
1407115132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1808A
- Practice address
- 5101 Prosperity Church Rd
Charlotte, NC 28269-8732 - Phone
- (704) 930-0758
- NPI assigned
- May 15, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1808A | NC | Primary |
Addresses
Primary practice location
5101 Prosperity Church Rd
Charlotte, NC 28269-8732
Mailing address
3001 Spring Forest Rd
Raleigh, NC 27616-2815
Phone (919) 424-5080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1808A | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337040000000",
"number": "1407115132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 SPRING FOREST RD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276162815",
"telephone_number": "919-424-5080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5101 PROSPERITY CHURCH RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282698732",
"telephone_number": "704-930-0758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLEY",
"first_name": "INDIA",
"middle_name": "D",
"name_prefix": "Ms.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-15",
"last_updated": "2012-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NC",
"license": "1808A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.