Provider Demographics
NPI:1508846874
Name:SAULSBURY, TIMOTHY M (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:SAULSBURY
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:PO BOX 1533
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1533
Mailing Address - Country:US
Mailing Address - Phone:712-234-8760
Mailing Address - Fax:712-234-8765
Practice Address - Street 1:915 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1031
Practice Address - Country:US
Practice Address - Phone:712-234-8760
Practice Address - Fax:712-234-8765
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA650018799OtherRR MEDICARE
IA214940Medicaid
SD5831833Medicaid
NE42147982000Medicaid
IAI1026Medicare UPIN
NE42147982000Medicaid
IA650018799OtherRR MEDICARE
IA650018799Medicare PIN