Provider Demographics
NPI:1558409391
Name:FORSYTH, TIMOTHY GEORGE
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GEORGE
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8334 CARDINAL COVE CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6335
Mailing Address - Country:US
Mailing Address - Phone:407-489-8907
Mailing Address - Fax:
Practice Address - Street 1:1119 SAXON BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8470
Practice Address - Country:US
Practice Address - Phone:389-774-4404
Practice Address - Fax:386-774-4496
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21245225100000X
MI5501011435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist