Provider Demographics
NPI:1871691121
Name:STOCKWELL, TIMOTHY POWELL (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:POWELL
Last Name:STOCKWELL
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 1:5276 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 1:5276 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 15393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist