Provider Demographics
NPI:1457967952
Name:TIMME, DOUGLAS LEE JR (DPT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:LEE
Last Name:TIMME
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 INDY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5198
Mailing Address - Country:US
Mailing Address - Phone:843-284-9275
Mailing Address - Fax:
Practice Address - Street 1:620 LONG POINT RD UNIT M
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8362
Practice Address - Country:US
Practice Address - Phone:843-284-9275
Practice Address - Fax:854-800-0773
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12518225100000X
GAPT014826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty