NPI 1063084812

Timothy Mott, PTA

Practitioner Physical Therapy Assistant Bloomington, IL

Practice location

Address: 1402 Leslie Dr, Bloomington, IL 61704-5405
Phone: (309) 603-2500
Mailing address: 713 Bunn St, Bloomington, IL 61701-5466

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence 160009271 (IL)

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Registry record

NPI: 1063084812
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 Jul 2021
Record last updated: 12 Jul 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.