Provider Demographics
NPI:1336552777
Name:ORRELL, TIMOTHY DANIEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:ORRELL
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 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:2303 HIGGINS RD
Practice Address - Street 2:STE A
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-9232
Practice Address - Country:US
Practice Address - Phone:816-858-0252
Practice Address - Fax:816-858-0253
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014023065225100000X
KS11-04859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
892034OtherOPTUM
MOMA4370083OtherMEDICARE PTAN
50762018OtherBCBS-KC
KSUSES NPIOtherBCBS-KANSAS
KSKA2868059OtherMEDICARE PTAN