Timothy Gannon, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00317700 Issued in NJ

Practice address

380 Demott LN
Somerset, NJ 08873-2762

Phone

(800) 571-6511

NPI assigned

Feb 8, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1346705803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 991",
            "city": "MALAGA",
            "state": "NJ",
            "postal_code": "083280991",
            "telephone_number": "865-278-7578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 DEMOTT LN",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088732762",
            "telephone_number": "800-571-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "TIMOTHY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-08",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "40QB00317700",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00317700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Gallinger, LCSW
• Stacey Galowitz, D.O.
• Mili Gami
• Aakash M Gandhi, PHARMS
• Ravi Venkata Gangavalli, MD
• Michael Yuan Gao, M.D.
• Garden State Health Care Solutions
• Nicole Gardner, BCBA
• Pauline Nicole Gasparro, OTR/L
• Charles J Gatt Jr., M.D.

• Physical Therapy Assistant in Somerset, NJ
• Providers in Somerset, NJ by specialty
• Physical Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.