Healthcare Provider Details

I. General information

NPI: 1003950676
Provider Name (Legal Business Name): TIMOTHY ROBERT LENGLE MA, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RIVERMONT AVE
LYNCHBURG VA
24503-1555
US

IV. Provider business mailing address

2500 RIVERMONT AVE
LYNCHBURG VA
24503-1555
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-8338
  • Fax:
Mailing address:
  • Phone: 609-434-8338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00071900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: