Provider Demographics
NPI:1467764670
Name:NIX, TIMOTHY WYCKOFF (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WYCKOFF
Last Name:NIX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 EATON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03872-7341
Mailing Address - Country:US
Mailing Address - Phone:304-417-2991
Mailing Address - Fax:
Practice Address - Street 1:24 MAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NH
Practice Address - Zip Code:03887-4420
Practice Address - Country:US
Practice Address - Phone:603-522-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003198225100000X
VA230520576225100000X
KYPT005628225100000X
OHPT.012959225100000X
NMPT5578225100000X
MEPT7141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist