Provider Demographics
NPI:1871859470
Name:TYMESON, JOANN (MPT)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:TYMESON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 RESTON PL
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-9356
Mailing Address - Country:US
Mailing Address - Phone:304-364-9191
Mailing Address - Fax:304-364-9193
Practice Address - Street 1:200 HIGH ST
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1200
Practice Address - Country:US
Practice Address - Phone:304-462-8933
Practice Address - Fax:304-462-8934
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist