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General NPI Number Information
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NPI Number | 1114004231
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Entity Type | Individual
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Provider Name | TIMOTHY S PEDERSEN MS, PT
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 17 SARAHS WAY
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City | FAIRHAVEN
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State | MA
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Zip | 02719-3161
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Country | US
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Telephone | 508-991-2918
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Fax | 508-994-3068
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Provider Business Mailing Address
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Address Line | 17 SARAHS WAY
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City | FAIRHAVEN
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State | MA
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Zip | 02719-3161
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Country | US
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Telephone | 508-991-2918
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Fax | 508-994-3068
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8305
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT01872
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License Number State | RI
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