Provider Demographics
NPI:1477088367
Name:KUBAT, EMILY (DPT)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:KUBAT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 VISTA BLVD # 176
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4559
Mailing Address - Country:US
Mailing Address - Phone:320-905-4364
Mailing Address - Fax:
Practice Address - Street 1:712 VISTA BLVD # 176
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-4559
Practice Address - Country:US
Practice Address - Phone:320-905-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01724300225100000X
MN11770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist