Provider Demographics
NPI:1477738391
Name:GRIFFIN, TIMOTHY PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:GRIFFIN
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 1:73 NEWTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:50 SEWALL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2645
Practice Address - Country:US
Practice Address - Phone:207-772-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME14302251E1200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000459401OtherMEDICARE PTAN
ME432825399Medicaid