Timothy J Bolen, PT
Individual provider Active NPI Specialist · Newton, KS
NPI 1104191899 · NPPES record last updated Mar 14, 2012
Key facts
- NPI
- 1104191899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 11-01593 (KS)
- Practice address
- 2311 S Kansas Rd
Newton, KS 67114-9032 - Phone
- (316) 283-7187
- Fax
- (316) 283-7189
- NPI assigned
- Mar 14, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-01593 | KS | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced PT of Newton, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11-01593 | KS | Yes |
Addresses
Primary practice location
2311 S Kansas Rd
Newton, KS 67114-9032
Mailing address
2311 S Kansas Rd
Newton, KS 67114-9032
Phone (316) 283-7187
Other names
- Mr. Tim Bolen
Other providers in Newton, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.