Provider Demographics
NPI:1013005479
Name:DOUBBLESTEIN, DAVID AARON (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:AARON
Last Name:DOUBBLESTEIN
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 1:4466 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:810-285-8523
Mailing Address - Fax:810-820-9582
Practice Address - Street 1:4466 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3170
Practice Address - Country:US
Practice Address - Phone:810-285-8523
Practice Address - Fax:810-820-9582
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013005479Medicaid
MIQ41656Medicare UPIN
MI1013005479Medicaid
MIP14980001Medicare ID - Type UnspecifiedMEMBER NUMBER
MI650F210220OtherBLUE CROSS BLUE SHIELD
MIP14980001Medicare ID - Type UnspecifiedMEMBER NUMBER