Provider Demographics
NPI:1386683654
Name:DREVNA, TIMOTHY (DPT,OCS,ATC,CSCS)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:DREVNA
Suffix:
Gender:M
Credentials:DPT,OCS,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N POINTE BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4134
Mailing Address - Country:US
Mailing Address - Phone:717-569-4184
Mailing Address - Fax:717-569-4192
Practice Address - Street 1:700 EDEN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4700
Practice Address - Country:US
Practice Address - Phone:717-569-4184
Practice Address - Fax:717-569-4192
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000203A2251S0007X
PAPT003023L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA415471OtherHEALTHAMERICA/ASSURANCE
PA9415781OtherPHCS
PA50057091OtherBLUE CROSS AND KEYSTONE
PA415471OtherHEALTHAMERICA/ASSURANCE