Provider Demographics
NPI:1174882542
Name:EVERETT, TIMOTHY (PT, DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:EVERETT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 LA MANCHA DR APT B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2195
Mailing Address - Country:US
Mailing Address - Phone:337-581-0124
Mailing Address - Fax:
Practice Address - Street 1:15 JANE JACOBS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6306
Practice Address - Country:US
Practice Address - Phone:828-669-8643
Practice Address - Fax:828-669-8648
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT272342251X0800X
NCP126532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic