Provider Demographics
NPI:1558301754
Name:LUBACZ, BETHANY (PT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:LUBACZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8101 E LOWRY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7195
Mailing Address - Country:US
Mailing Address - Phone:720-865-6072
Mailing Address - Fax:
Practice Address - Street 1:500 W 144TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9328
Practice Address - Country:US
Practice Address - Phone:303-665-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26959Medicare ID - Type Unspecified
ILK26958Medicare ID - Type Unspecified
ILQ67644Medicare UPIN