Provider Demographics
NPI:1649839572
Name:ALLEY, TIMOTHY CHARLES (LMP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:ALLEY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-0858
Mailing Address - Country:US
Mailing Address - Phone:509-486-1096
Mailing Address - Fax:509-486-2928
Practice Address - Street 1:39 CLARKSTON MILL RD
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-0858
Practice Address - Country:US
Practice Address - Phone:509-429-7104
Practice Address - Fax:509-486-2928
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist