Provider Demographics
NPI:1376333104
Name:TIMM, KALEB MICHAEL (PTA)
Entity type:Individual
Prefix:MR
First Name:KALEB
Middle Name:MICHAEL
Last Name:TIMM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1355 VILLA PARK CIR APT 7
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-6110
Mailing Address - Country:US
Mailing Address - Phone:920-655-1954
Mailing Address - Fax:
Practice Address - Street 1:751 DEERWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1601
Practice Address - Country:US
Practice Address - Phone:920-550-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant