Bradley Tillman

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT3770 Issued in AR

Practice address

610 W Grand Ave
Hot Springs, AR 71901-3922

Phone

(501) 625-7800

Fax

(501) 325-2727

NPI assigned

Nov 4, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1972908804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 REDWOOD",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720152525",
            "telephone_number": "501-625-7800",
            "fax_number": "501-325-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 W GRAND AVE",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719013922",
            "telephone_number": "501-625-7800",
            "fax_number": "501-325-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "BRADLEY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-11-04",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "AR",
            "license": "PT3770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204765721",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Breanna Tidwell
• Mary Tidwell, RBT
• Tiffany L. Corjay, Inc.
• Autumn Tillery
• Jodi Carnahan Tillery, RRT
• Parker Ellen Tinnell
• Lisa D Tinney, APN
• Deborah Lea Tipps, M.S., CCC-SLP
• Tipton and Powell Pediatric Dentistry PLLC
• Blayne Hillyard Tipton, DDS

• Pediatric Physical Therapist in Hot Springs, AR
• Providers in Hot Springs, AR by specialty
• Pediatric Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; 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.