Provider Demographics
NPI:1275658809
Name:RUBIN, MARY-JO (MA, PT, AP)
Entity Type:Individual
Prefix:MRS
First Name:MARY-JO
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MA, PT, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10803 WHARTON WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1113
Mailing Address - Country:US
Mailing Address - Phone:561-776-7170
Mailing Address - Fax:561-776-7171
Practice Address - Street 1:8645 N MILITARY TRL
Practice Address - Street 2:SUITE 401
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6294
Practice Address - Country:US
Practice Address - Phone:561-776-7170
Practice Address - Fax:561-776-7171
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95171100000X
FL2048208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884383096OtherMEDICAID WAIVER
FL884383000Medicaid
FLY7548OtherBLUE CROSS BLUE SHIELD
FLY7548OtherBLUE CROSS BLUE SHIELD