Provider Demographics
NPI:1578556981
Name:TOURVILLE, TIMOTHY WARD (MED, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WARD
Last Name:TOURVILLE
Suffix:
Gender:M
Credentials:MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5793
Mailing Address - Country:US
Mailing Address - Phone:802-656-3239
Mailing Address - Fax:802-656-4247
Practice Address - Street 1:95 CARRIGAN DR
Practice Address - Street 2:STAFFORD HALL 4 MCCLURE MUSCULOSKELETAL RESEARCH CENTER
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-1746
Practice Address - Country:US
Practice Address - Phone:802-656-3239
Practice Address - Fax:802-656-4247
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-0000032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist