Provider Demographics
NPI:1043687502
Name:MAIK, TIMMY
Entity type:Individual
Prefix:
First Name:TIMMY
Middle Name:
Last Name:MAIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1815
Mailing Address - Country:US
Mailing Address - Phone:215-574-9388
Mailing Address - Fax:215-574-9188
Practice Address - Street 1:933 SPRING ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1815
Practice Address - Country:US
Practice Address - Phone:215-574-9388
Practice Address - Fax:215-574-9188
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000290225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant