Provider Demographics
NPI:1235114448
Name:HORNAK, TIMOTHY JAMES (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
Last Name:HORNAK
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 1:25 N 14TH ST
Mailing Address - Street 2:STE 550
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6204
Mailing Address - Country:US
Mailing Address - Phone:408-294-3922
Mailing Address - Fax:408-294-4657
Practice Address - Street 1:25 N 14TH ST
Practice Address - Street 2:STE 550
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6204
Practice Address - Country:US
Practice Address - Phone:408-294-3922
Practice Address - Fax:408-294-4657
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT114440Medicare PIN