Provider Demographics
NPI:1003939802
Name:DUBICKI, JOANNE CHRISTINE (PTA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:CHRISTINE
Last Name:DUBICKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3128
Mailing Address - Country:US
Mailing Address - Phone:631-234-3035
Mailing Address - Fax:
Practice Address - Street 1:3279 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7673
Practice Address - Country:US
Practice Address - Phone:631-580-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant