Healthcare Provider Details

I. General information

NPI: 1780304865
Provider Name (Legal Business Name): TIMERA P BATES DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CATOCTIN CIR SE STE 112
LEESBURG VA
20175-3614
US

IV. Provider business mailing address

12701 FAIR LAKES CIR STE 102
FAIRFAX VA
22033-4913
US

V. Phone/Fax

Practice location:
  • Phone: 571-918-0197
  • Fax: 571-918-4253
Mailing address:
  • Phone: 571-918-0197
  • Fax: 571-918-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305218065
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302107
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29868
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23365
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: