Provider Demographics
NPI:1396247078
Name:TRAMMELL, TIMOTHY J (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:TRAMMELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RAINBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:662-571-5283
Mailing Address - Fax:
Practice Address - Street 1:746 E FIFTEENTH ST
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2706
Practice Address - Country:US
Practice Address - Phone:662-746-4032
Practice Address - Fax:662-746-0967
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist