Provider Demographics
NPI:1023575636
Name:O'CONNOR, TIMOTHY (PT, DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 STRAWBERRY HILL DR APT C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4558
Mailing Address - Country:US
Mailing Address - Phone:973-668-6942
Mailing Address - Fax:
Practice Address - Street 1:412 W PALMER ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4042
Practice Address - Country:US
Practice Address - Phone:980-987-7885
Practice Address - Fax:949-655-8592
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist