Provider Demographics
NPI:1245842426
Name:KESTERMONT, TIMOTHY ALAN (PTA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALAN
Last Name:KESTERMONT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 TIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:SIDMAN
Mailing Address - State:PA
Mailing Address - Zip Code:15955-4943
Mailing Address - Country:US
Mailing Address - Phone:814-487-7388
Mailing Address - Fax:
Practice Address - Street 1:277 HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-2369
Practice Address - Country:US
Practice Address - Phone:814-467-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEO12151225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant