Provider Demographics
NPI:1235359282
Name:PIKE, TIM WILLIAM (ATC)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:WILLIAM
Last Name:PIKE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MOBERLY BUILDING
Mailing Address - Street 2:521 LANCASTER AVE
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-0284
Mailing Address - Country:US
Mailing Address - Phone:859-622-2147
Mailing Address - Fax:859-622-8857
Practice Address - Street 1:203 MOBERLY BUILDING
Practice Address - Street 2:521 LANCASTER AVE
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-0284
Practice Address - Country:US
Practice Address - Phone:859-622-2147
Practice Address - Fax:859-622-8857
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT5662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer