Provider Demographics
NPI:1275987570
Name:HUYNH, TIMOTHY T (ATC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:T
Last Name:HUYNH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13392 CABALLERO WAY
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-1004
Mailing Address - Country:US
Mailing Address - Phone:703-994-9197
Mailing Address - Fax:
Practice Address - Street 1:4500 PATRIOT CIR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4468
Practice Address - Country:US
Practice Address - Phone:703-993-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260023822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer