Provider Demographics
NPI:1578964821
Name:GOBRECHT, TIMOTHY JUSTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JUSTIN
Last Name:GOBRECHT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1703
Mailing Address - Country:US
Mailing Address - Phone:610-521-3333
Mailing Address - Fax:610-521-2263
Practice Address - Street 1:100 E CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1703
Practice Address - Country:US
Practice Address - Phone:610-521-3333
Practice Address - Fax:610-521-2263
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant