Demitris Marlena Tillman, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

576 Jefferson Ave
Fort Eustis, VA 23604-1602

Phone

(757) 314-7666

NPI assigned

Jul 9, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215561600000",
    "number": "1588827554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 SHANNON DR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236083125",
            "telephone_number": "757-234-6328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 JEFFERSON AVE",
            "city": "FORT EUSTIS",
            "state": "VA",
            "postal_code": "236041602",
            "telephone_number": "757-314-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "DEMITRIS",
        "middle_name": "MARLENA",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-09",
        "last_updated": "2008-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Patricia Swisher, PHARMD
• Johnathan Matthew Taylor, DNP, APRN, NP-C, CEN
• Letitia Ann Taylor
• Kathryn Christina Thomas
• James Leon Thompson, D.M.D.
• Gregory Marc Todd
• Clifton Trinidad, PA-C
• Johnna Jolene Turner, RD, LD
• Bernadette Udeozor, NP
• Usameddac Ft Eustis VA

• Physical Therapy Assistant in Fort Eustis, VA
• Providers in Fort Eustis, VA by specialty
• Physical Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.