Provider Demographics
NPI:1629440060
Name:NEAL, TIMOTHY (MS, ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:NEAL
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 DAMPIER CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-4100
Mailing Address - Country:US
Mailing Address - Phone:315-877-5151
Mailing Address - Fax:
Practice Address - Street 1:8285 DAMPIER CIR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-4100
Practice Address - Country:US
Practice Address - Phone:315-877-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer