Healthcare Provider Details

I. General information

NPI: 1700292539
Provider Name (Legal Business Name): TIMOTHY BRANDEN BUBNICK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1588 LEESTOWN RD STE 120
LEXINGTON KY
40511-2365
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 859-317-8086
  • Fax: 859-317-8894
Mailing address:
  • Phone: 423-238-8930
  • Fax: 423-254-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007378
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: