MEDICARE: MR. TIMOTHY B DUBLE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-09661	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063401479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY B DUBLE PT

Provider Business Mailing Address
First Line	:	320 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44481-1206
Country	:	US
Telephone Number	:	330-399-2221
Fax Number	:	330-394-0122

Provider Business Practice Location Address
First Line	:	1230 N MERIDIAN RD
Second Line	:	SUITE B
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-1019
Country	:	US
Telephone Number	:	330-793-9500
Fax Number	:	330-793-9512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/17/2007

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