Provider Demographics
NPI:1831928076
Name:MISAJON, TIMOTHY JOHN ANGELES (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY JOHN
Middle Name:ANGELES
Last Name:MISAJON
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 1:180 W WASHINGTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4332
Mailing Address - Country:US
Mailing Address - Phone:260-409-7810
Mailing Address - Fax:
Practice Address - Street 1:180 W WASHINGTON CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4332
Practice Address - Country:US
Practice Address - Phone:260-409-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015444A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist