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NPI Code Detail

MEDICARE: BRIAN JON TIMM PT

MEDICARE: BRIAN JON 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
1225100000XPhysical Therapist3049OR

Other Identifiers

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

General Provider Information

NPI Number : 1841276342
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN JON TIMM PT
Provider Business Mailing Address
First Line : 16083 SW UPPER BOONES FERRY RD
Second Line : STE 300
City : TIGARD
State : OR
Zip : 97224-7736
Country : US
Telephone Number : 800-219-8835
Fax Number : 503-639-9699
Provider Business Practice Location Address
First Line : 2200 NE NEFF RD
Second Line : SUITE 202
City : BEND
State : OR
Zip : 97701-6337
Country : US
Telephone Number : 541-388-7738
Fax Number : 541-388-7785
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2005
Last Update Date : 11/13/2012

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