Healthcare Provider Details

I. General information

NPI: 1538276365
Provider Name (Legal Business Name): TIMOTHY HANEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 PURCELL DR
XENIA OH
45385-1266
US

IV. Provider business mailing address

171 PURCELL DR
XENIA OH
45385-1211
US

V. Phone/Fax

Practice location:
  • Phone: 937-272-4725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: