Provider Demographics
NPI:1245314251
Name:PETREY, TIMOTHY W (LPT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:W
Last Name:PETREY
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-733-9333
Mailing Address - Fax:513-588-2479
Practice Address - Street 1:7109 BACHMAN RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-8242
Practice Address - Country:US
Practice Address - Phone:937-446-3500
Practice Address - Fax:937-446-3599
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.008539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist