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General NPI Number Information
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NPI Number | 1710425210
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Entity Type | Individual
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Provider Name | TANNER RAY TIMMERMAN PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 301 W BROADWAY STE 100
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-9071
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Country | US
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Telephone | 712-322-9688
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Fax | 712-322-1299
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Provider Business Mailing Address
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Address Line | 625 ENTERPRISE DR
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City | OAK BROOK
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State | IL
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Zip | 60523-8813
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Country | US
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Telephone | 630-575-1980
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Fax | 630-928-5080
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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 | 3673
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License Number State | NE
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