Provider Demographics
NPI:1962746602
Name:ROURKE, TIMOTHY FRANCIS (DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FRANCIS
Last Name:ROURKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 SHARON DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433
Mailing Address - Country:US
Mailing Address - Phone:810-659-6552
Mailing Address - Fax:
Practice Address - Street 1:9480 E M 21
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866
Practice Address - Country:US
Practice Address - Phone:989-834-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist