Provider Demographics
NPI:1689728099
Name:THOR, TIM E (PT)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:E
Last Name:THOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 NW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6164
Mailing Address - Country:US
Mailing Address - Phone:954-344-3168
Mailing Address - Fax:954-344-3183
Practice Address - Street 1:8710 NW 21ST CT
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6164
Practice Address - Country:US
Practice Address - Phone:954-344-3168
Practice Address - Fax:954-344-3183
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT1849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist