Provider Demographics
NPI:1538709183
Name:KUBIK, KENDALL JENKINS (PT)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:JENKINS
Last Name:KUBIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:KENDALL
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1167 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3591
Mailing Address - Country:US
Mailing Address - Phone:850-380-3916
Mailing Address - Fax:
Practice Address - Street 1:1167 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3591
Practice Address - Country:US
Practice Address - Phone:850-380-3916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist