1548416134 NPI number — DR. TIMOTHY P COUSENS JR. PT,DPT,MS

Table of content: DR. TIMOTHY P COUSENS JR. PT,DPT,MS (NPI 1548416134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548416134 NPI number — DR. TIMOTHY P COUSENS JR. PT,DPT,MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUSENS
Provider First Name:
TIMOTHY
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PT,DPT,MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548416134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
NAVAJO HEALTH FOUNDATION/SAGE MEMORIAL HOSPITAL/PT DEPT
Provider Business Mailing Address City Name:
GANADO
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86505-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-755-4566
Provider Business Mailing Address Fax Number:
928-755-4567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 264 AND 191 SOUTH
Provider Second Line Business Practice Location Address:
NAVAJO HEALTH FOUNDATION/SAGE MEMORIAL HOSPITAL/PT DEPT
Provider Business Practice Location Address City Name:
GANADO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-755-4566
Provider Business Practice Location Address Fax Number:
928-755-4567
Provider Enumeration Date:
08/14/2008

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:  5211 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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