Provider Demographics
NPI:1952301780
Name:STILES, TIMOTHY J (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:STILES
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 1:1981 DOUBLE EAGLE DR STE A
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2132
Mailing Address - Country:US
Mailing Address - Phone:307-752-8354
Mailing Address - Fax:307-466-1237
Practice Address - Street 1:1981 DOUBLE EAGLE DR STE A
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2132
Practice Address - Country:US
Practice Address - Phone:307-752-8354
Practice Address - Fax:307-466-1237
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-2175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8812Medicare ID - Type Unspecified
ME060679OtherBC/BS OF MAINE