Provider Demographics
NPI:1124218821
Name:TIMM, KRISTY L (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:L
Last Name:TIMM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:L
Other - Last Name:KUTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:23 W GLANN RD
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4026
Mailing Address - Country:US
Mailing Address - Phone:239-537-3139
Mailing Address - Fax:607-625-4251
Practice Address - Street 1:23 W GLANN RD
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-4026
Practice Address - Country:US
Practice Address - Phone:239-537-3139
Practice Address - Fax:607-625-4251
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist