Individual
TIMOTHY GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
380 DEMOTT LN, SOMERSET, NJ 08873-2762
(800) 571-6511
Mailing address
PO BOX 991, MALAGA, NJ 08328-0991
(865) 278-7578
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
40QB00317700
NJ
225200000X
Physical Therapy Assistant
Primary
40QB00317700
NJ
Other
Enumeration date
02/08/2019
Last updated
02/08/2019
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