Provider Demographics
NPI:1033825252
Name:LUBIARZ, ROXANN ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:ROXANN
Middle Name:ROSE
Last Name:LUBIARZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ROXANN
Other - Middle Name:ROSE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 76 BOX 6004
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319-0061
Mailing Address - Country:US
Mailing Address - Phone:702-481-4840
Mailing Address - Fax:
Practice Address - Street 1:USHIROKUBO-125-7
Practice Address - Street 2:
Practice Address - City:MISAWA
Practice Address - State:AMORI
Practice Address - Zip Code:033-0022
Practice Address - Country:JP
Practice Address - Phone:315-226-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist