Provider Demographics
NPI:1164660007
Name:LUBBE, JOHANNA (PT)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:LUBBE
Suffix:
Gender:F
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:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-0097
Mailing Address - Country:US
Mailing Address - Phone:914-875-9430
Mailing Address - Fax:914-875-9435
Practice Address - Street 1:892 ROUTE 35
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518-1141
Practice Address - Country:US
Practice Address - Phone:914-875-9430
Practice Address - Fax:914-875-9435
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist