Individual
TIMOTHY MOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1402 LESLIE DR, BLOOMINGTON, IL 61704-5405
(309) 603-2500
Mailing address
713 BUNN ST, BLOOMINGTON, IL 61701-5466
(309) 287-9926
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160009271
IL
Other
Enumeration date
07/12/2021
Last updated
07/12/2021
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