Jenna Lynn Tillman, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10727 Issued in MN

Practice address

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527

Phone

(952) 883-1000

NPI assigned

Jun 29, 2017

Sex

Female

Sole proprietor

No

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)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Capernaum Pediatric Therapy, Inc.

  • Specialist
  • Richfield, MN
  • NPI 1619978228
  NPD (past)

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667520000000",
    "number": "1922529015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15301 GROVE CIR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694475",
            "telephone_number": "952-993-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "telephone_number": "952-883-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "JENNA",
        "middle_name": "LYNN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-29",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "10727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl L Tibesar, PT
• Anna Leigh Tierney
• Robert Tierney, M.D.
• Lisa Thanh Tieu, DNP, CNP
• Olivia Nicole Tigue
• Angela Tilsen, COTA
• Crosby Nils Tindal, PHARMD
• Alice Auma Tindi, LICSW
• Ethel Ykachi Tobrise, RN
• Cynthia A Toher

• Physical Therapist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.