Provider Demographics
NPI:1124774294
Name:TILSON, CORINE (LMT)
Entity type:Individual
Prefix:
First Name:CORINE
Middle Name:
Last Name:TILSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:SAINT REGIS
Mailing Address - State:MT
Mailing Address - Zip Code:59866-0313
Mailing Address - Country:US
Mailing Address - Phone:808-747-1818
Mailing Address - Fax:
Practice Address - Street 1:1070 N RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-2004
Practice Address - Country:US
Practice Address - Phone:406-541-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist