Provider Demographics
NPI:1528356714
Name:LONERGAN, TIMOTHY CARLTON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CARLTON
Last Name:LONERGAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:3450 COBB PKWY NW
Practice Address - Street 2:STE. 140
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8351
Practice Address - Country:US
Practice Address - Phone:678-473-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist