Provider Demographics
NPI:1871782631
Name:MARAHRENS, TIMOTHY EDSON (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EDSON
Last Name:MARAHRENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9588
Mailing Address - Country:US
Mailing Address - Phone:910-686-2549
Mailing Address - Fax:910-395-5773
Practice Address - Street 1:3909 OLEANDER DR
Practice Address - Street 2:SUITE D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6730
Practice Address - Country:US
Practice Address - Phone:910-686-2549
Practice Address - Fax:910-395-5773
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist