Provider Demographics
NPI:1073061941
Name:ENGQUIST, TIM JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:JAMES
Last Name:ENGQUIST
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 S DAHLIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7331
Mailing Address - Country:US
Mailing Address - Phone:719-232-8438
Mailing Address - Fax:
Practice Address - Street 1:3086 S DAHLIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7331
Practice Address - Country:US
Practice Address - Phone:719-232-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist