Provider Demographics
NPI:1235143454
Name:PILCHARD, TIMOTHY (MSPT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:PILCHARD
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21732 WATER OAK DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9643
Mailing Address - Country:US
Mailing Address - Phone:209-532-9052
Mailing Address - Fax:
Practice Address - Street 1:13808 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8864
Practice Address - Country:US
Practice Address - Phone:209-532-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 209172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT209170Medicare ID - Type UnspecifiedPROVIDER NUMBER