Provider Demographics
NPI:1043652993
Name:JAMES, TIMOTHY CLARK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CLARK
Last Name:JAMES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W 114TH ST
Mailing Address - Street 2:APT. 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3043
Mailing Address - Country:US
Mailing Address - Phone:812-631-0145
Mailing Address - Fax:
Practice Address - Street 1:118 W 114TH ST
Practice Address - Street 2:APT. 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3043
Practice Address - Country:US
Practice Address - Phone:812-631-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62035513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist