Provider Demographics
NPI:1053453944
Name:BLECKE, TIMOTHY PAUL (PT, CERT MDT, NCS)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:BLECKE
Suffix:
Gender:M
Credentials:PT, CERT MDT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9643
Mailing Address - Country:US
Mailing Address - Phone:614-379-1120
Mailing Address - Fax:614-573-0502
Practice Address - Street 1:9240 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9643
Practice Address - Country:US
Practice Address - Phone:614-379-1120
Practice Address - Fax:614-573-0502
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8566225100000X
AZ5931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist