Provider Demographics
NPI:1558709618
Name:KUBAS, AMBER LOUISE (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LOUISE
Last Name:KUBAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S 12TH ST
Mailing Address - Street 2:212
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7483
Mailing Address - Country:US
Mailing Address - Phone:701-290-4191
Mailing Address - Fax:
Practice Address - Street 1:1501 N 12TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2713
Practice Address - Country:US
Practice Address - Phone:701-751-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDKUB-83-4690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist