Provider Demographics
NPI:1346040011
Name:CRUTCHFIELD, TIMOTHY BLAIR JR
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BLAIR
Last Name:CRUTCHFIELD
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 FALLS OF NEUSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3550
Mailing Address - Country:US
Mailing Address - Phone:919-803-0738
Mailing Address - Fax:
Practice Address - Street 1:7310 MILLHOUSE RD STE 125
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-5106
Practice Address - Country:US
Practice Address - Phone:919-803-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist