Active NPI
Timothy David Dellwo, DPT
- Physical Therapist
- Jacksonville, FL
National Provider Identifier
1316351588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 29323
- Practice address
- 3901 University Blvd S
Jacksonville, FL 32216-4312 - Phone
- (904) 345-7200
- NPI assigned
- Jun 16, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 29323 | FL | Primary |
Addresses
Primary practice location
3901 University Blvd S
Jacksonville, FL 32216-4312
Mailing address
1412 1St St N Apt 204
Jacksonville Beach, FL 32250-7376
Phone (318) 918-6895
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29323 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1316351588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1412 1ST ST N APT 204",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "322507376",
"telephone_number": "318-918-6895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 UNIVERSITY BLVD S",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322164312",
"telephone_number": "904-345-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELLWO",
"first_name": "TIMOTHY",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-16",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "29323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.