MEDICARE: DR. TIMOTHY JAMES HRUSKA 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	2251E1200X	Ergonomics Physical Therapist
2	2251G0304X	Geriatric Physical Therapist
3	2251N0400X	Neurology Physical Therapist
4	2251P0200X	Pediatric Physical Therapist
5	2251S0007X	Sports Physical Therapist
6	2251X0800X	Orthopedic Physical Therapist
7	225100000X	Physical Therapist	5501302245	MI

General Provider Information

NPI Number	:	1659092112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JAMES HRUSKA PT

Provider Business Mailing Address
First Line	:	16009 LEONE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-4063
Country	:	US
Telephone Number	:	906-221-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	16009 LEONE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-4063
Country	:	US
Telephone Number	:	586-232-3644
Fax Number	:	248-579-0197

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	09/02/2022

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