Provider Demographics
NPI:1669547337
Name:PLUMLEY, TIMOTHY CHARLES (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:PLUMLEY
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 1:112 HARCOURT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3946
Mailing Address - Country:US
Mailing Address - Phone:740-392-8811
Mailing Address - Fax:740-392-6485
Practice Address - Street 1:351 S LANE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2319
Practice Address - Country:US
Practice Address - Phone:419-562-6686
Practice Address - Fax:419-562-6625
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2533566Medicaid
OH2533566Medicaid
OH4034972Medicare PIN