Provider Demographics
NPI:1427358738
Name:KUBALA, RADOSLAW TOMASZ
Entity Type:Individual
Prefix:
First Name:RADOSLAW
Middle Name:TOMASZ
Last Name:KUBALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 E FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1637
Mailing Address - Country:US
Mailing Address - Phone:773-685-8482
Mailing Address - Fax:
Practice Address - Street 1:1460 E FOREST AVE
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1637
Practice Address - Country:US
Practice Address - Phone:773-685-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant