Provider Demographics
NPI:1316335359
Name:REMMERT, TIMOTHY
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:REMMERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 S RIDGEWOOD AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8478
Mailing Address - Country:US
Mailing Address - Phone:386-788-5021
Mailing Address - Fax:386-788-5021
Practice Address - Street 1:1635 S RIDGEWOOD AVE STE 225
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8478
Practice Address - Country:US
Practice Address - Phone:386-788-5021
Practice Address - Fax:386-788-5021
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty