Provider Demographics
NPI:1447028915
Name:DIAMOND, TIMOTHY DANIEL (DPT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 CANTON ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-2070
Mailing Address - Country:US
Mailing Address - Phone:609-781-7384
Mailing Address - Fax:
Practice Address - Street 1:945 E HAVERFORD RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3814
Practice Address - Country:US
Practice Address - Phone:610-525-1223
Practice Address - Fax:610-525-5797
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02228900225100000X
PAPT03196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist