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NPI Code Detail

MEDICARE: TIMOTHY OLTHOFF DPT

MEDICARE: TIMOTHY OLTHOFF DPT
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
1225100000XPhysical Therapist5501017892MI

General Provider Information

NPI Number : 1679022115
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY OLTHOFF DPT
Provider Business Mailing Address
First Line : 3826 44TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-3919
Country : US
Telephone Number : 616-554-0918
Fax Number :
Provider Business Practice Location Address
First Line : 3826 44TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-3919
Country : US
Telephone Number : 616-554-0918
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2016
Last Update Date : 09/26/2016

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Directions to “ TIMOTHY OLTHOFF DPT” Practice Location

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