Provider Demographics
NPI:1851694855
Name:TIM TINIUS PHD PA
Entity type:Organization
Organization Name:TIM TINIUS PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TINIUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:320-654-9311
Mailing Address - Street 1:225 N BENTON DR
Mailing Address - Street 2:#104
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1575
Mailing Address - Country:US
Mailing Address - Phone:320-654-9311
Mailing Address - Fax:320-654-9248
Practice Address - Street 1:225 N BENTON DR
Practice Address - Street 2:#104
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1575
Practice Address - Country:US
Practice Address - Phone:320-654-9311
Practice Address - Fax:320-654-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty