Provider Demographics
NPI:1356613368
Name:DEAN, TIMOTHY ROY (PTA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ROY
Last Name:DEAN
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 1:6135 ROOSEVELT HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830
Mailing Address - Country:US
Mailing Address - Phone:706-655-5637
Mailing Address - Fax:706-655-5661
Practice Address - Street 1:6391 ROOSEVELT HIGHWAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-0268
Practice Address - Country:US
Practice Address - Phone:706-655-5636
Practice Address - Fax:706-655-5661
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA 002888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant