Basic Information
| Provider Information | |||||||||
| NPI: | 1770771677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINCHLIFFE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4511 ROCKSIDE RD | ||||||||
| Address2: | STE 330 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441312199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169010400 | ||||||||
| FaxNumber: | 2169010401 | ||||||||
| Practice Location | |||||||||
| Address1: | 4511 ROCKSIDE RD | ||||||||
| Address2: | STE 330 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441312199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169010400 | ||||||||
| FaxNumber: | 2169010401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2007 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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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 | 171W00000X | Y | Other Service Providers | Contractor |
No ID Information.