Provider Demographics
NPI:1255315362
Name:FOLEY, TIM J (PT)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:J
Last Name:FOLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1686
Mailing Address - Country:US
Mailing Address - Phone:541-386-9735
Mailing Address - Fax:541-386-2015
Practice Address - Street 1:1808 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1686
Practice Address - Country:US
Practice Address - Phone:541-386-9735
Practice Address - Fax:541-386-2015
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK114356Medicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER