Basic Information
| Provider Information | |||||||||
| NPI: | 1174698047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIMMONS | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2654 HANKINSON RD | ||||||||
| Address2: | |||||||||
| City: | GRANVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430239706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148056392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2242 W DUBLIN GRANVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WORTHINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430853351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148413900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2006 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8543 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.