Provider Demographics
NPI:1932138435
Name:KUBISTEK, TIMOTHY (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:KUBISTEK
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 1:2030 ADER RD
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-4500
Mailing Address - Country:US
Mailing Address - Phone:724-327-3553
Mailing Address - Fax:724-733-9430
Practice Address - Street 1:2030 ADER RD
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-4500
Practice Address - Country:US
Practice Address - Phone:724-327-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016749970004Medicaid
PA232924881OtherTAX ID