Provider Demographics
NPI:1225416332
Name:QUATTLEBAUM, TIMOTHY DUSTIN (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DUSTIN
Last Name:QUATTLEBAUM
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 1:60 SHUFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-7406
Mailing Address - Country:US
Mailing Address - Phone:828-894-0277
Mailing Address - Fax:828-894-0278
Practice Address - Street 1:1129 E MARION ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4843
Practice Address - Country:US
Practice Address - Phone:704-471-0001
Practice Address - Fax:704-471-9990
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ53854F938OtherMEDICARE PART B