Provider Demographics
NPI:1215180906
Name:TIMM, VICTORIA F (MPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:F
Last Name:TIMM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3701 NW CARY PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8431
Mailing Address - Country:US
Mailing Address - Phone:919-388-0111
Mailing Address - Fax:919-388-8668
Practice Address - Street 1:3701 NW CARY PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8431
Practice Address - Country:US
Practice Address - Phone:919-388-0111
Practice Address - Fax:919-388-8668
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC11902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212524Medicaid
NC0687KOtherBCBS OF NC
NC7212524Medicaid