Provider Demographics
NPI:1427258698
Name:FAILS, TIMOTHY J (ATC/L)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:FAILS
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LOMA COLORADO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6562
Mailing Address - Country:US
Mailing Address - Phone:505-896-9505
Mailing Address - Fax:
Practice Address - Street 1:301 LOMA COLORADO BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6562
Practice Address - Country:US
Practice Address - Phone:505-896-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer