Provider Demographics
NPI:1245295294
Name:TWOMEY, JOHN C (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:TWOMEY
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 1:3900 HUNGRY HORSE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7310
Mailing Address - Country:US
Mailing Address - Phone:928-854-4776
Mailing Address - Fax:928-854-4857
Practice Address - Street 1:1795 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5673
Practice Address - Country:US
Practice Address - Phone:928-854-4776
Practice Address - Fax:928-854-4857
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
70251Medicare ID - Type Unspecified