Provider Demographics
NPI:1588628226
Name:CUBBISON, DANIELLE D (MSPT ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:D
Last Name:CUBBISON
Suffix:
Gender:F
Credentials:MSPT ATC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:D
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:272 PACKETBOAT RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-9311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2160
Practice Address - Country:US
Practice Address - Phone:717-242-4840
Practice Address - Fax:717-242-4841
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001926216Medicaid
PA075139R9XMedicare Oscar/Certification