Provider Demographics
NPI:1891733143
Name:DOTSON, TIMOTHY DANIEL (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:DOTSON
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 1:1790 HAMILL RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4905
Mailing Address - Country:US
Mailing Address - Phone:423-771-4600
Mailing Address - Fax:423-771-4601
Practice Address - Street 1:1790 HAMILL RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4905
Practice Address - Country:US
Practice Address - Phone:423-771-4600
Practice Address - Fax:423-771-4601
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3156797OtherBCBST-GROUP NUMBER
TN3156797OtherMEDICARE GROUP UPIN
TN4227759OtherBCBS TN INDIVIDUAL
TN4227759OtherBCBS TN INDIVIDUAL