Provider Demographics
NPI:1710597059
Name:MCGINNIS, TIMOTHY K (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:K
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 S RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2423
Mailing Address - Country:US
Mailing Address - Phone:708-927-6461
Mailing Address - Fax:
Practice Address - Street 1:9834 S HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3363
Practice Address - Country:US
Practice Address - Phone:708-927-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty