Provider Demographics
NPI:1972201390
Name:TIMPONE, LISA CHRISTINE (ATC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINE
Last Name:TIMPONE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 MILLERTON PL
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5482
Mailing Address - Country:US
Mailing Address - Phone:209-692-0667
Mailing Address - Fax:
Practice Address - Street 1:3800 MILLERTON PL
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-5482
Practice Address - Country:US
Practice Address - Phone:209-692-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600453372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer