Provider Demographics
NPI:1083440309
Name:STAUDMYER, TIMOTHY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:STAUDMYER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33808 DARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-9447
Mailing Address - Country:US
Mailing Address - Phone:301-535-2484
Mailing Address - Fax:
Practice Address - Street 1:19775 BELMONT EXECUTIVE PLZ STE 125
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7606
Practice Address - Country:US
Practice Address - Phone:571-498-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist