Provider Demographics
NPI:1174552285
Name:DUMOULIN, TIMM K (PT)
Entity type:Individual
Prefix:MR
First Name:TIMM
Middle Name:K
Last Name:DUMOULIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 JERICHO ST
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9324
Mailing Address - Country:US
Mailing Address - Phone:802-295-3205
Mailing Address - Fax:
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-1618
Practice Address - Country:US
Practice Address - Phone:603-298-5595
Practice Address - Fax:603-298-5205
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0806546Y0NH01OtherBLUE CROSS/BLUE SHIELD
NH9150551OtherCIGNA
VTDUMO6371OtherBLUE CROSS VERMONT
NH40652187Medicaid
NH9150551OtherCIGNA