Provider Demographics
NPI:1467488866
Name:KUBERSKI, KENNETH (ATC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:KUBERSKI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8323 MAGIC LEAF RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2527
Mailing Address - Country:US
Mailing Address - Phone:703-644-8569
Mailing Address - Fax:703-273-4512
Practice Address - Street 1:10675 LEE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4314
Practice Address - Country:US
Practice Address - Phone:703-352-0925
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260006052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer