Provider Demographics
NPI:1679302186
Name:TIMME, CARRIE LYN (PTA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYN
Last Name:TIMME
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYN
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2804 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:MYERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21773-8502
Mailing Address - Country:US
Mailing Address - Phone:517-599-2258
Mailing Address - Fax:
Practice Address - Street 1:7407 WILLOW RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-2500
Practice Address - Country:US
Practice Address - Phone:301-644-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5944225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant