Provider Demographics
NPI:1285617852
Name:TIMM, KENT E (PHD, DPT, PT)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:E
Last Name:TIMM
Suffix:
Gender:M
Credentials:PHD, DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 PRAIRIE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1281
Mailing Address - Country:US
Mailing Address - Phone:989-790-3564
Mailing Address - Fax:
Practice Address - Street 1:7329 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8895
Practice Address - Country:US
Practice Address - Phone:989-573-8266
Practice Address - Fax:989-573-8269
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X, 2251X0800X
MI5501300257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic