Provider Demographics
NPI:1538134952
Name:CORDIAL, TIM J (PT)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:J
Last Name:CORDIAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9347
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-9347
Mailing Address - Country:US
Mailing Address - Phone:406-721-8858
Mailing Address - Fax:406-542-0960
Practice Address - Street 1:701 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3904
Practice Address - Country:US
Practice Address - Phone:406-721-8858
Practice Address - Fax:406-542-0960
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000344097Medicaid