Provider Demographics
NPI:1548568678
Name:RUBIN, MARIETTA DENISE (MPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:MARIETTA
Middle Name:DENISE
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 VIA EL CHICO
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6756
Mailing Address - Country:US
Mailing Address - Phone:310-378-2064
Mailing Address - Fax:
Practice Address - Street 1:348 VIA EL CHICO
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6756
Practice Address - Country:US
Practice Address - Phone:310-378-2064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist