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General NPI Number Information
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NPI Number | 1497358451
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Entity Type | Individual
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Provider Name | TIMOTHY MAX WALLENBURG PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 17420 MEINIG AVE
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City | SANDY
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State | OR
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Zip | 97055-8068
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Country | US
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Telephone | 503-427-0118
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Fax | 503-427-0279
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Provider Business Mailing Address
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Address Line | 2001 SOLAR DR STE 150
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City | OXNARD
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State | CA
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Zip | 93036-0680
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Country | US
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Telephone | 805-604-1924
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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 | 65063
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License Number State | OR
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