Provider Demographics
NPI:1255602710
Name:TILLSON, DONALD PAUL (ATC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:PAUL
Last Name:TILLSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 LITTLE FALLS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22213-1211
Mailing Address - Country:US
Mailing Address - Phone:703-237-1456
Mailing Address - Fax:703-237-1401
Practice Address - Street 1:6600 LITTLE FALLS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22213-1211
Practice Address - Country:US
Practice Address - Phone:703-237-1456
Practice Address - Fax:703-237-1401
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260000022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer