Healthcare Provider Details

I. General information

NPI: 1003444654
Provider Name (Legal Business Name): TRENTON PETER TIMMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 TATE BLVD SE STE 600
HICKORY NC
28602-1433
US

IV. Provider business mailing address

1449 S CHURCH ST APT 536
CHARLOTTE NC
28203-6428
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-5500
  • Fax:
Mailing address:
  • Phone: 616-293-6976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202007565
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0010-10530
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: