Provider Demographics
NPI:1629016142
Name:HUBER, TIMOTHY JON (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JON
Last Name:HUBER
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 1:9801 FRONTIER AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065
Mailing Address - Country:US
Mailing Address - Phone:425-831-2300
Mailing Address - Fax:425-831-2361
Practice Address - Street 1:9575 ETHAN WADE WAY SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065
Practice Address - Country:US
Practice Address - Phone:425-831-2300
Practice Address - Fax:425-831-2361
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1461225100000X
WAPT60146430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT68372Medicaid
AK160703Medicare ID - Type Unspecified