Basic Information
| Provider Information | |||||||||
| NPI: | 1669547337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLUMLEY | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 HARCOURT RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430503946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403928811 | ||||||||
| FaxNumber: | 7403926485 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 S LANE ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448202319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195626686 | ||||||||
| FaxNumber: | 4195626625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 11/04/2011 | ||||||||
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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 | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2533566 | 05 | OH | MEDICAID |