Provider Demographics
NPI:1639774441
Name:GORELICK, TIMOTHY (PTA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:GORELICK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 ABBOTT LAKES LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3039
Mailing Address - Country:US
Mailing Address - Phone:281-799-6955
Mailing Address - Fax:
Practice Address - Street 1:3115 COLLEGE PARK DR STE 109
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4001
Practice Address - Country:US
Practice Address - Phone:936-273-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2077679225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant