Provider Demographics
NPI:1265723449
Name:WILLIAMSON, TIMOTHY RAY (PT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:RAY
Last Name:WILLIAMSON
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 1:1005 E 23RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-0800
Mailing Address - Country:US
Mailing Address - Phone:866-784-2329
Mailing Address - Fax:
Practice Address - Street 1:802 2ND ST SE
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3329
Practice Address - Country:US
Practice Address - Phone:406-873-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6454225100000X
MT195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist