Provider Demographics
NPI:1982892949
Name:FLAHERTY, TIMOTHY (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:FLAHERTY
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:2022 E OLD LINCOLN HIGHWAY
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-891-5150
Practice Address - Fax:215-891-1410
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014202L225100000X
DEJ10002270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2001620000OtherIBC
1308253OtherPABS
92832901OtherCAREFIRST
DE1982892949Medicaid
11795711OtherCAQH
1982892949OtherCHAMPUS TRICARE
5070-0088OtherNCA
DE1982892949Medicaid
DE132506Y0XMedicare PIN
1982892949OtherCHAMPUS TRICARE