1780074773 NPI number — ANNA L TIMON DPT

Table of content: ANNA L TIMON DPT (NPI 1780074773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780074773 NPI number — ANNA L TIMON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMON
Provider First Name:
ANNA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAUGHENBAUGH
Provider Other First Name:
ANNA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780074773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16441-0134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-900-4742
Provider Business Mailing Address Fax Number:
814-679-4158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16441-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-900-4742
Provider Business Practice Location Address Fax Number:
814-679-4158
Provider Enumeration Date:
01/28/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305209092 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)