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General NPI Number Information
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NPI Number | 1477580579
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Entity Type | Individual
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Provider Name | TIMOTHY A. HALE P.T.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 840 S FAIRMONT AVE STE. 5
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City | LODI
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State | CA
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Zip | 95240-5105
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Country | US
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Telephone | 209-368-8870
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Fax | 209-368-2253
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Provider Business Mailing Address
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Address Line | 12715 HOBDAY RD
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City | WILTON
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State | CA
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Zip | 95693-8516
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Country | US
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Telephone |
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Fax |
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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 | 32745
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License Number State | CA
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