MEDICARE: TIMOTHY BRUCE ROCKWELL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00007393	WA

General Provider Information

NPI Number	:	1184873218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY BRUCE ROCKWELL PT

Provider Business Mailing Address
First Line	:	451 SW SEDGWICK RD
Second Line	:	STE 110
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-6425
Country	:	US
Telephone Number	:	360-874-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 SW SEDGWICK RD
Second Line	:	STE 110
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-6425
Country	:	US
Telephone Number	:	360-874-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	09/12/2008

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