Provider Demographics
NPI:1114583804
Name:KASHUBA, MARIAH ANN (PTA)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:ANN
Last Name:KASHUBA
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 1:339 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2593
Mailing Address - Country:US
Mailing Address - Phone:330-498-8200
Mailing Address - Fax:
Practice Address - Street 1:198 E GROVER ST
Practice Address - Street 2:
Practice Address - City:KILLBUCK
Practice Address - State:OH
Practice Address - Zip Code:44637-9546
Practice Address - Country:US
Practice Address - Phone:330-231-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.011637225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant