Basic Information
| Provider Information | |||||||||
| NPI: | 1588842520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALPOLE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13145 LITTLEFIELD RD | ||||||||
| Address2: | 13145 | ||||||||
| City: | CHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238362645 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 EPPES ST | ||||||||
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| City: | HOPEWELL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238602717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045411445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2008 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.