Provider Demographics
NPI:1275553141
Name:DOANE, TIMOTHY S (MA, ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:DOANE
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1711
Mailing Address - Country:US
Mailing Address - Phone:610-954-7953
Mailing Address - Fax:
Practice Address - Street 1:641 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-3107
Practice Address - Country:US
Practice Address - Phone:610-758-6303
Practice Address - Fax:610-758-6850
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001987A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer