Basic Information
| Provider Information | |||||||||
| NPI: | 1467764670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIX | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | WYCKOFF | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5170 US ROUTE 60 EAST | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257052065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045284600 | ||||||||
| FaxNumber: | 3047333143 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 13TH ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411024510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033290910 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2010 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 230520576 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT003198 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT005628 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.