Provider Demographics
NPI:1932611290
Name:TILTON, NICHOLAS J (ATC)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:J
Last Name:TILTON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CITY CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2981
Mailing Address - Country:US
Mailing Address - Phone:936-202-5202
Mailing Address - Fax:936-202-5230
Practice Address - Street 1:19939 CHASEWOOD PARK DR APT 9211
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1154
Practice Address - Country:US
Practice Address - Phone:603-553-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer