Provider Demographics
NPI:1447551171
Name:KING, TIMOTHY (DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:KING
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 1:1952 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1209
Mailing Address - Country:US
Mailing Address - Phone:203-672-9227
Mailing Address - Fax:203-621-3162
Practice Address - Street 1:60 OLD NEW MILFORD RD STE 2A
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2434
Practice Address - Country:US
Practice Address - Phone:203-775-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080008939CT04OtherBLUECROSS BLUE SHIELD