Provider Demographics
NPI:1891743787
Name:CRUNK, TIMOTHY J (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:CRUNK
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 1:105A REGENCY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5210
Mailing Address - Country:US
Mailing Address - Phone:864-373-9520
Mailing Address - Fax:864-373-9522
Practice Address - Street 1:105A REGENCY COMMONS DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5210
Practice Address - Country:US
Practice Address - Phone:864-373-9520
Practice Address - Fax:864-373-9522
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ339858359Medicare ID - Type Unspecified