Provider Demographics
NPI:1164890109
Name:KUBIK, JARED
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:KUBIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 GROUSE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0500
Mailing Address - Country:US
Mailing Address - Phone:507-884-9132
Mailing Address - Fax:
Practice Address - Street 1:9720 GROUSE RIDGE LN
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-0500
Practice Address - Country:US
Practice Address - Phone:507-884-9132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist