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Individual
TIMOTHY KUBISTEK
Active
Individual
TIMOTHY KUBISTEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT016738
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016749970004
—
PA
01
—
232924881
TAX ID
PA
Enumeration date
06/30/2006
Last updated
10/26/2021
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