Provider Demographics
NPI:1063401479
Name:DUBLE, TIMOTHY B (PT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:B
Last Name:DUBLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-1206
Mailing Address - Country:US
Mailing Address - Phone:330-399-2221
Mailing Address - Fax:330-394-0122
Practice Address - Street 1:1230 N MERIDIAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1019
Practice Address - Country:US
Practice Address - Phone:330-793-9500
Practice Address - Fax:330-793-9512
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-09661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0222253Medicaid
OH0222253Medicaid