Provider Demographics
NPI:1326320375
Name:BOURNE, TIMOTHY LEWIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEWIS
Last Name:BOURNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 COUNTY ROAD 852
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-5739
Mailing Address - Country:US
Mailing Address - Phone:256-572-2522
Mailing Address - Fax:
Practice Address - Street 1:636 COUNTY ROAD 852
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-5739
Practice Address - Country:US
Practice Address - Phone:256-572-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist