MEDICARE: JILL I. TIMM 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	6168-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649225970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL I. TIMM PT

Provider Business Mailing Address
First Line	:	4000 N PROVIDENCE AVE
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-8018
Country	:	US
Telephone Number	:	920-257-2000
Fax Number	:	920-257-2004

Provider Business Practice Location Address
First Line	:	114 E GREENTREE ROAD
Second Line	:
City	:	CLINTONVILLE
State	:	WI
Zip	:	54929
Country	:	US
Telephone Number	:	715-823-3336
Fax Number	:	715-823-3936

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/13/2007

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Directions to “ JILL I. TIMM PT” Practice Location

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