Provider Demographics
NPI:1164901526
Name:ADORNETTO, TIMOTHY OWEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:OWEN
Last Name:ADORNETTO
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 1:16572 W GREENWAY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-2183
Mailing Address - Country:US
Mailing Address - Phone:623-584-3400
Mailing Address - Fax:
Practice Address - Street 1:16572 W GREENWAY RD STE 103
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-2183
Practice Address - Country:US
Practice Address - Phone:623-584-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist