Provider Demographics
NPI:1447238423
Name:MUDGETT-MCGEOCH, TIM (PT)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:MUDGETT-MCGEOCH
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 1:23 DUTTON FARM LN
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9473
Mailing Address - Country:US
Mailing Address - Phone:610-869-6833
Mailing Address - Fax:610-869-4433
Practice Address - Street 1:206 N JENNERSVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9326
Practice Address - Country:US
Practice Address - Phone:610-869-6833
Practice Address - Fax:610-869-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089201Medicare ID - Type UnspecifiedMEDICARE ID