Doctor Name: | TIMOTHY LEE BANTHRUM |
NPI Number: | 1316981269 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MPT, OCS, CSCS |
License Number: | PT25650 |
Business Practice Address: | 671 W Naomi Ave Arcadia, CA - 910077502 |
Business Phone Number: | 6264467027 |
Business Fax Number: | 6264464723 |
Mailing Address: | 2403 Kellogg Ct, DUARTE |
State: | CA |
Postal Code: | 910102155 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT25650 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
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 |