Provider Demographics
NPI:1811953771
Name:NURRENBERN, TIMOTHY W (LAT, A,TC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:W
Last Name:NURRENBERN
Suffix:
Gender:M
Credentials:LAT, A,TC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 813
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639-9533
Mailing Address - Country:US
Mailing Address - Phone:812-868-1047
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 813
Practice Address - Street 2:
Practice Address - City:HAUBSTADT
Practice Address - State:IN
Practice Address - Zip Code:47639-9533
Practice Address - Country:US
Practice Address - Phone:812-868-1047
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000091A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer