Provider Demographics
NPI:1811989841
Name:ANNE, TIMOTHY (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ANNE
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 1:515 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-3005
Mailing Address - Country:US
Mailing Address - Phone:585-227-2310
Mailing Address - Fax:585-227-2312
Practice Address - Street 1:515 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3005
Practice Address - Country:US
Practice Address - Phone:585-227-2310
Practice Address - Fax:585-227-2312
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0447Medicare ID - Type UnspecifiedGROUP NUMBER
NYCC7503Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
NYP37440Medicare UPIN