Provider Demographics
NPI:1275548927
Name:MCCULLOUGH, TIMOTHY (PT,ATC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:PT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:SMART PHYSICAL THERAPY, LLC
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5834
Mailing Address - Country:US
Mailing Address - Phone:603-526-7627
Mailing Address - Fax:603-676-7967
Practice Address - Street 1:11 PLEASANT ST.
Practice Address - Street 2:SMART PHYSICAL THERAPY LLC
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5834
Practice Address - Country:US
Practice Address - Phone:603-526-7627
Practice Address - Fax:603-676-7967
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist