Provider Demographics
NPI:1447623012
Name:TILLY, ERIN R (RMT, LMT)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:R
Last Name:TILLY
Suffix:
Gender:F
Credentials:RMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 HARDLUCK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5976
Mailing Address - Country:US
Mailing Address - Phone:907-888-2344
Mailing Address - Fax:907-451-6699
Practice Address - Street 1:455 3RD AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4737
Practice Address - Country:US
Practice Address - Phone:907-888-2344
Practice Address - Fax:907-451-6699
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ006369172M00000X
AK104002225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist