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General NPI Number Information
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NPI Number | 1356613368
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Entity Type | Individual
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Provider Name | TIMOTHY ROY DEAN PTA
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Gender | Male
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 6391 ROOSEVELT HIGHWAY
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City | WARM SPRINGS
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State | GA
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Zip | 31830-0268
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Country | US
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Telephone | 706-655-5636
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Fax | 706-655-5661
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Provider Business Mailing Address
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Address Line | 6135 ROOSEVELT HIGHWAY
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City | WARM SPRINGS
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State | GA
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Zip | 31830
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Country | US
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Telephone | 706-655-5637
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Fax | 706-655-5661
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 002888
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License Number State | GA
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