Provider Demographics
NPI:1932258829
Name:AHERN, TIMOTHY (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:AHERN
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 1:315 W 9TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2501
Mailing Address - Country:US
Mailing Address - Phone:509-326-8878
Mailing Address - Fax:509-326-1157
Practice Address - Street 1:725 N STANLEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8940
Practice Address - Country:US
Practice Address - Phone:509-299-7379
Practice Address - Fax:509-299-7307
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8450637Medicaid
WA1350PEOtherASURIS PIN MEDICALLAKE
WA0208406OtherL & I PIN
WA8859813Medicare PIN