Provider Demographics
NPI:1538380449
Name:ERTLE, TIMOTHY (MP,T)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:ERTLE
Suffix:
Gender:M
Credentials:MP,T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 N PINE CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202
Mailing Address - Country:US
Mailing Address - Phone:330-562-9314
Mailing Address - Fax:
Practice Address - Street 1:26001 S WOODLAND
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-378-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHU5937842251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH593784OtherPHYSICAL THERAPY LISCENSE