Provider Demographics
NPI:1477127116
Name:LUBAHN, MICHAEL GERALD (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GERALD
Last Name:LUBAHN
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 COUNTY HIGHWAY I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5414
Mailing Address - Country:US
Mailing Address - Phone:715-726-4200
Mailing Address - Fax:
Practice Address - Street 1:2655 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5414
Practice Address - Country:US
Practice Address - Phone:715-726-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12351225100000X
WI15932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist