James Randolph Tilton Jr., PT
Individual provider Active NPI Physical Therapist · Ithaca, MI
NPI 1720007248 · NPPES record last updated Feb 1, 2024
Key facts
- NPI
- 1720007248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501008948 (MI)
- Practice address
- 203 Dilts Rd
Ithaca, MI 48847-9475 - Phone
- (989) 875-2266
- Fax
- (989) 875-2225
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ithaca Physical Therapy, Inc
Practice addresses (Care Compare)
203 Dilts Rd
Ithaca, MI 48847-9475
Phone (989) 875-2266
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040706000471 | MI | Practitioner - Physical Therapist in Private Practice | 8820075146 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501008948 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ithaca Physical Therapy, Inc | Physical Therapist | Current |
Accepting new patients |
| Peak Physical Therapy, Inc. | Physical Therapist | Past |
Accepting new patients |
Locations
733 W Warwick Dr
Unit A
Alma, MI 48801
Phone (989) 463-0345
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501008948 | MI | Yes |
Addresses
Primary practice location
203 Dilts Rd
Ithaca, MI 48847-9475
Mailing address
203 Dilts Rd
Ithaca, MI 48847-9475
Phone (989) 875-2266
Other practice location 1
733 W Warwick Dr Unit A
Alma, MI 48801-1115
Phone (989) 463-0345
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A2741KD1 | Medicaid | IL | |
| 200770947 | Other | TAX ID | |
| 650B910270 | Other | MI | BCBSM AND BCN |
| 607648000 | Other | MI | OFFICE OF WORKERS COMP. |
| 64-70128 | Other | MI | PHP |
| 7594704 | Other | MI | AETNA |
Other providers in Ithaca, MI
- Jeffrey Charles Spalding
- Sparrow Carson Hospital
- Michelle L Spitzley
- Matthew A Stack
- Michael Andrew Stack
- Trauma and Addiction Solutions PLLC
- Shelby Vanscoyoc
- Carol A Waters
- William McCarthy, Inc.
- Hallie J Wilson
All providers in Ithaca, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.