Provider Demographics
NPI:1922318864
Name:ALTENBURG, TIMOTHY W (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:ALTENBURG
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 1:296 OUTBOARD DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9604
Mailing Address - Country:US
Mailing Address - Phone:843-318-6621
Mailing Address - Fax:
Practice Address - Street 1:296 OUTBOARD DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9604
Practice Address - Country:US
Practice Address - Phone:843-318-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist