Basic Information
Provider Information
NPI: 1003149469
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STARR
FirstName: TIMOTHY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 24960 WALNUT ST
Address2: APARTMENT 16
City: NEWHALL
State: CA
PostalCode: 913211060
CountryCode: US
TelephoneNumber: 6193184293
FaxNumber:  
Practice Location
Address1: 5601 DE SOTO AVE
Address2: PHYSICAL THERAPY DEPARTMENT
City: WOODLAND HILLS
State: CA
PostalCode: 913676701
CountryCode: US
TelephoneNumber: 8187192930
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/16/2009
LastUpdateDate: 09/16/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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