Provider Demographics
NPI:1063789964
Name:HERLIHY, TIM (LMT)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:HERLIHY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ARBOR CLUB DR
Mailing Address - Street 2:UNIT 216
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2666
Mailing Address - Country:US
Mailing Address - Phone:904-473-5913
Mailing Address - Fax:
Practice Address - Street 1:3016 3RD ST S
Practice Address - Street 2:UNIT 102
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6011
Practice Address - Country:US
Practice Address - Phone:904-473-5913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist