Provider Demographics
NPI:1659465870
Name:TIMOTHY STOCKWELL PT PA
Entity Type:Organization
Organization Name:TIMOTHY STOCKWELL PT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:STOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-598-9444
Mailing Address - Street 1:5276 SE 39TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-0634
Mailing Address - Country:US
Mailing Address - Phone:352-598-9444
Mailing Address - Fax:352-694-2614
Practice Address - Street 1:5267 SE 39TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-0634
Practice Address - Country:US
Practice Address - Phone:352-598-9444
Practice Address - Fax:352-694-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 15393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty