Provider Demographics
NPI:1427945799
Name:KUBINA, RENATA (MEDICAL MASSAGE PRAC)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:KUBINA
Suffix:
Gender:F
Credentials:MEDICAL MASSAGE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MAIN ST UNIT W-202
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8151
Mailing Address - Country:US
Mailing Address - Phone:805-710-1127
Mailing Address - Fax:
Practice Address - Street 1:97 MAIN ST UNIT W-202
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-8151
Practice Address - Country:US
Practice Address - Phone:805-710-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0025314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist