Provider Demographics
NPI:1902918139
Name:TILLEY, VICTORIA SLOAN
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SLOAN
Last Name:TILLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:SLOAN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2002 BARTLETT CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-6921
Mailing Address - Country:US
Mailing Address - Phone:919-614-1923
Mailing Address - Fax:919-644-6646
Practice Address - Street 1:1101 BARTLETT CIR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-6772
Practice Address - Country:US
Practice Address - Phone:919-644-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078XGOtherBCBS
MI650G110070OtherBCBS
MI650G110070OtherBCBS