Healthcare Provider Details

I. General information

NPI: 1700502531
Provider Name (Legal Business Name): TIMOTHY JOHN HUFFMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 TONAWANDA TRL
BEAVERCREEK OH
45430-1961
US

IV. Provider business mailing address

1100 SHAWNEE RD
LIMA OH
45805-3529
US

V. Phone/Fax

Practice location:
  • Phone: 937-526-5033
  • Fax:
Mailing address:
  • Phone: 419-999-2010
  • Fax: 419-999-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: