Healthcare Provider Details

I. General information

NPI: 1417248741
Provider Name (Legal Business Name): KYLE G TIMM PT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 HILLCREST DR
SHERMAN TX
75092-5507
US

IV. Provider business mailing address

1216 HILLCREST DR
SHERMAN TX
75092-5507
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-7457
  • Fax: 903-893-6671
Mailing address:
  • Phone: 903-893-7457
  • Fax: 903-893-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1176660
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: