Provider Demographics
NPI:1568181386
Name:KATHOL, TIMOTHY JOHN
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:KATHOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 270TH ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8091
Mailing Address - Country:US
Mailing Address - Phone:269-680-1869
Mailing Address - Fax:564-204-1107
Practice Address - Street 1:9902 270TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8091
Practice Address - Country:US
Practice Address - Phone:269-680-1869
Practice Address - Fax:564-204-1107
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61323404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61323404OtherLMT