Provider Demographics
NPI:1598858243
Name:WILLINGHAM, TIMOTHY R (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:R
Last Name:WILLINGHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SW CORPORATE VW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1244
Mailing Address - Country:US
Mailing Address - Phone:785-228-6100
Mailing Address - Fax:785-228-6101
Practice Address - Street 1:601 SW CORPORATE VW
Practice Address - Street 2:SUITE 220
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1244
Practice Address - Country:US
Practice Address - Phone:785-228-6100
Practice Address - Fax:785-228-6101
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110417002OtherMEDICARE PTAN