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General NPI Number Information
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NPI Number | 1730775651
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Entity Type | Individual
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Provider Name | GRETCHEN TIMMONS PTA
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 225 CLEARFIELD AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-1815
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Country | US
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Telephone | 757-457-5100
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Fax | 757-961-3696
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Provider Business Mailing Address
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Address Line | 5417 WESLEYAN DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6922
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Country | US
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Telephone | 757-699-4793
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306605740
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License Number State | VA
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