Provider Demographics
NPI:1538134952
Name:CORDIAL, TIM J (PT)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:J
Last Name:CORDIAL
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:PO BOX 9347
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-9347
Mailing Address - Country:US
Mailing Address - Phone:406-721-8858
Mailing Address - Fax:406-542-0960
Practice Address - Street 1:701 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3904
Practice Address - Country:US
Practice Address - Phone:406-721-8858
Practice Address - Fax:406-542-0960
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2572251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000061750OtherBLUE CROSS
MT0000344097Medicaid