Provider Demographics
NPI:1992873574
Name:TIMM, MATTHEW RYAN (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RYAN
Last Name:TIMM
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 W 150TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2544
Mailing Address - Country:US
Mailing Address - Phone:816-520-4755
Mailing Address - Fax:913-308-5356
Practice Address - Street 1:6608 W 150TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2544
Practice Address - Country:US
Practice Address - Phone:816-520-4755
Practice Address - Fax:913-308-5356
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018265225100000X
KS11-06311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist