Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306604418 | VA |
NPI | 1013363746 |
---|---|
Provider Name | Timothy Beierle |
First Address | Roanoke, VA 24016-3916 |
Second Address | Roanoke, VA 24015-3829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2016 |
Last Update Date | 12/05/2016 |