Provider Demographics
NPI:1083679583
Name:CUBBAGE, WILLIAM ROGER JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROGER
Last Name:CUBBAGE
Suffix:JR
Gender:M
Credentials:ATC
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Mailing Address - Street 1:2911 EXPLORER DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4705
Mailing Address - Country:US
Mailing Address - Phone:502-456-2529
Mailing Address - Fax:502-899-4175
Practice Address - Street 1:4011 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3122
Practice Address - Country:US
Practice Address - Phone:502-736-2169
Practice Address - Fax:717-412-9573
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-06-17
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Provider Licenses
StateLicense IDTaxonomies
KYAT0582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer