Provider Demographics
NPI:1497416796
Name:TIIMAN, KEELY
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:
Last Name:TIIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12770 COIT RD STE 870
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1455
Mailing Address - Country:US
Mailing Address - Phone:972-756-0500
Mailing Address - Fax:972-756-0448
Practice Address - Street 1:12770 COIT RD STE 870
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1455
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:972-756-0448
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2163605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant