MEDICARE: HEIDEE TIMBOL 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	022701	NY

General Provider Information

NPI Number	:	1235318627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDEE TIMBOL PT

Provider Business Mailing Address
First Line	:	7600 MAJORCA PL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7217 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5634
Country	:	US
Telephone Number	:	718-837-7583
Fax Number	:

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	06/12/2024

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