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NPI Code Detail

MEDICARE: MR. TIMOTHY WILLIS HINES LMT

MEDICARE: MR. TIMOTHY WILLIS HINES LMT
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
1225700000XMassage TherapistMT030213TX

General Provider Information

NPI Number : 1629611918
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY WILLIS HINES LMT
Provider Business Mailing Address
First Line : 1325 HEIDI DR
Second Line :
City : PLANO
State : TX
Zip : 75025-2808
Country : US
Telephone Number : 977-527-5278
Fax Number :
Provider Business Practice Location Address
First Line : 101 W MCDERMOTT DR # 107
Second Line :
City : ALLEN
State : TX
Zip : 75013-2751
Country : US
Telephone Number : 214-552-4949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2019
Last Update Date : 10/19/2019

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