Provider Demographics
NPI:1780564518
Name:TIMONEN, TERI JO (PTA)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:JO
Last Name:TIMONEN
Suffix:
Gender:F
Credentials:PTA
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 673
Mailing Address - Street 2:4746 TOWER ROAD
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-0673
Mailing Address - Country:US
Mailing Address - Phone:715-394-5591
Mailing Address - Fax:715-394-5098
Practice Address - Street 1:1800 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2008
Practice Address - Country:US
Practice Address - Phone:715-394-5591
Practice Address - Fax:715-394-5098
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA3073225200000X
WI4307-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant