Individual
DR. TIMOTHY LAWRENCE BASOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
136 E LAKE ST, EPHRATA, PA 17522
(717) 738-7979
Mailing address
136 E LAKE ST, EPHRATA, PA 17522
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT022566
PA
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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