Provider Demographics
NPI:1568181386
Name:KATHOL, TIMOTHY JOHN
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:KATHOL
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 1:7207 265TH ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6274
Mailing Address - Country:US
Mailing Address - Phone:360-629-6544
Mailing Address - Fax:360-629-4520
Practice Address - Street 1:7207 265TH ST NW STE 102
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6274
Practice Address - Country:US
Practice Address - Phone:360-629-6544
Practice Address - Fax:360-629-4520
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61323404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61323404OtherLMT