Provider Demographics
NPI:1639662844
Name:DAILING, TIM E (LMT, MNT)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:E
Last Name:DAILING
Suffix:
Gender:M
Credentials:LMT, MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 HENDRICKS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3303
Mailing Address - Country:US
Mailing Address - Phone:904-348-5511
Mailing Address - Fax:
Practice Address - Street 1:1819 HENDRICKS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3303
Practice Address - Country:US
Practice Address - Phone:904-348-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83753225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist