| Doctor Name: | TIMOTHY G FREDERICKS |
| NPI Number: | 1134246226 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | 5501004832 |
| Business Practice Address: | 37650 Professional Center Dr Suite 105a Livonia, MI - 48152 |
| Business Phone Number: | 7349531745 |
| Business Fax Number: | 7349531743 |
| Mailing Address: | 173 Harvey St, PLYMOUTH |
| State: | MI |
| Postal Code: | 48170 |
| Phone Number: | 7342234815 |
| Fax Number: | |
| NPI Enumeration Date: | 03/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501004832 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |