Provider Demographics
NPI:1215088059
Name:FLICKER, TIMOTHY ANDREW (MPT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:FLICKER
Suffix:
Gender:M
Credentials:MPT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 MARGO LN
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-1961
Mailing Address - Country:US
Mailing Address - Phone:208-406-2057
Mailing Address - Fax:
Practice Address - Street 1:4922 YELLOWSTONE AVE STE J
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2360
Practice Address - Country:US
Practice Address - Phone:208-237-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist