MEDICARE: DEVAN TIMOTHY

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

General Provider Information

NPI Number	:	1427697432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVAN TIMOTHY

Provider Business Mailing Address
First Line	:	175 NJ-70
Second Line	:
City	:	MEDFORD
State	:	NJ
Zip	:	08055
Country	:	US
Telephone Number	:	609-714-3378
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 NJ-70
Second Line	:
City	:	MEDFORD
State	:	NJ
Zip	:	08055
Country	:	US
Telephone Number	:	609-714-3378
Fax Number	:

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

Provider Enumeration Date	:	12/23/2019
Last Update Date	:	02/04/2026

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Directions to “ DEVAN TIMOTHY ” Practice Location

Language	Start Address	Practice Location

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