Provider Demographics
NPI:1194535062
Name:TILLMAN, MILEYDA ESCANO (LMT)
Entity type:Individual
Prefix:
First Name:MILEYDA
Middle Name:ESCANO
Last Name:TILLMAN
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 1:11031 NE 78TH TER
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-3350
Mailing Address - Country:US
Mailing Address - Phone:360-359-5235
Mailing Address - Fax:
Practice Address - Street 1:11031 NE 78TH TER
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621-3350
Practice Address - Country:US
Practice Address - Phone:360-359-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA101624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist