Provider Demographics
NPI:1952896391
Name:RUBOTTOM, TIM EARL I (ATC)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:EARL
Last Name:RUBOTTOM
Suffix:I
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 1:7723 CHAMBERS CREEK RD W
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98467-2017
Mailing Address - Country:US
Mailing Address - Phone:253-620-8300
Mailing Address - Fax:
Practice Address - Street 1:7723 CHAMBERS CREEK RD W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-2017
Practice Address - Country:US
Practice Address - Phone:253-620-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1600334722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer