Provider Demographics
NPI:1235318627
Name:TIMBOL, HEIDEE (PT)
Entity type:Individual
Prefix:
First Name:HEIDEE
Middle Name:
Last Name:TIMBOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEIDEE
Other - Middle Name:
Other - Last Name:TIMBOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:7600 MAJORCA PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7217 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5634
Practice Address - Country:US
Practice Address - Phone:718-837-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist