Individual
TIMOTHY DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 VILLA DR, DAPHNE, AL 36526-4653
(251) 621-4431
Mailing address
12451 WILDFLOWER DR, MOBILE, AL 36608-8798
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1922 PTA3551
AL
Other
Enumeration date
08/28/2008
Last updated
08/28/2008
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