Healthcare Provider Details

I. General information

NPI: 1174698047
Provider Name (Legal Business Name): TRAVIS R TIMMONS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2006
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 W DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3351
US

IV. Provider business mailing address

2654 HANKINSON RD
GRANVILLE OH
43023-9706
US

V. Phone/Fax

Practice location:
  • Phone: 614-841-3900
  • Fax:
Mailing address:
  • Phone: 614-805-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8543
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: