Individual
MR. TIMOTHY EUGENE MCGONIGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT FAGO MPT
Contact information
Practice address
115 NATOMA ST, FOLSOM, CA 95630
(916) 355-8500
(916) 355-8196
Mailing address
115 NATOMA ST, FOLSOM, CA 95630
(916) 355-8500
(916) 355-8196
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT22365
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT10120
BLUE CROSS
—
01
—
ZZZ611242
BLUE SHIELD
CA
Enumeration date
10/24/2006
Last updated
07/08/2007
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