Provider Demographics
NPI:1437630308
Name:LUBERIS, ABNY
Entity Type:Individual
Prefix:
First Name:ABNY
Middle Name:
Last Name:LUBERIS
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 1:805 S VANDEVEER ST APT D
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-3655
Mailing Address - Country:US
Mailing Address - Phone:954-709-9535
Mailing Address - Fax:
Practice Address - Street 1:507 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-3012
Practice Address - Country:US
Practice Address - Phone:512-756-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212779224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212779OtherOCCUPATIONAL THERAPY LICENSE