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General NPI Number Information
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NPI Number | 1548416134
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Entity Type | Individual
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Provider Name | TIMOTHY P COUSENS JR. PT,DPT,MS
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Gender | Male
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | HIGHWAY 264 AND 191 SOUTH NAVAJO HEALTH FOUNDATION/SAGE MEMORIAL HOSPITAL/PT DEPT
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City | GANADO
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State | AZ
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Zip | 86505
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Country | US
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Telephone | 928-755-4566
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Fax | 928-755-4567
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Provider Business Mailing Address
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Address Line | PO BOX 457 NAVAJO HEALTH FOUNDATION/SAGE MEMORIAL HOSPITAL/PT DEPT
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City | GANADO
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State | AZ
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Zip | 86505-0457
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Country | US
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Telephone | 928-755-4566
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Fax | 928-755-4567
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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 | 5211
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License Number State | AZ
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