MEDICARE: TIMOTHY DANIEL HOURIGAN PTA

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	225200000X	Physical Therapy Assistant	PTA003582	GA

General Provider Information

NPI Number	:	1598123069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY DANIEL HOURIGAN PTA

Provider Business Mailing Address
First Line	:	588 GOLF CREST DR
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-5985
Country	:	US
Telephone Number	:	770-841-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1995 N PARK PL SE
Second Line	:	SUITE 410
City	:	ATLANTA
State	:	GA
Zip	:	30339-7801
Country	:	US
Telephone Number	:	770-850-0390
Fax Number	:	770-818-9762

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

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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