Provider Demographics
NPI:1801069653
Name:STONE, TIMOTHY HAROLD JR (PT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:HAROLD
Last Name:STONE
Suffix:JR
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 1:1137 BAYWATER DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3118
Mailing Address - Country:US
Mailing Address - Phone:803-739-0793
Mailing Address - Fax:
Practice Address - Street 1:1137 BAYWATER DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3118
Practice Address - Country:US
Practice Address - Phone:803-739-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist