Healthcare Provider Details

I. General information

NPI: 1982702791
Provider Name (Legal Business Name): TIMOTHY D HUMANN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 HIGHWAY 11 E
BULLS GAP TN
37711-3416
US

IV. Provider business mailing address

2024 E ANDREW JOHNSON HWY
MORRISTOWN TN
37814-5410
US

V. Phone/Fax

Practice location:
  • Phone: 423-235-7115
  • Fax:
Mailing address:
  • Phone: 423-586-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT85
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: