Individual
TIMOTHY RAY PRICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
815 N LARKIN AVE, SUITE 207, JOLIET, IL 60435-3438
(815) 207-4200
(815) 207-4200
Mailing address
7633 CHURCH ST, MORTON GROVE, IL 60053-1618
(847) 470-1287
(847) 470-1287
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
211-000025
IL
222Z00000X
Orthotist
213-000028
IL
224P00000X
Prosthetist
211-000025
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XX-XXX1669
—
IL
Enumeration date
06/27/2007
Last updated
07/10/2008
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