Provider Demographics
NPI:1235318627
Name:TIMBOL, MA. HEIDEE (PT)
Entity Type:Individual
Prefix:
First Name:MA. HEIDEE
Middle Name:
Last Name:TIMBOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:HEIDEE
Other - Last Name:TIMBOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2590 36TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4541
Mailing Address - Country:US
Mailing Address - Phone:917-403-9622
Mailing Address - Fax:
Practice Address - Street 1:7217 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5634
Practice Address - Country:US
Practice Address - Phone:718-837-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist