Provider Demographics
NPI:1588676258
Name:TUBBS, ELIZABETH RAE (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RAE
Last Name:TUBBS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 NW 86TH AVE APT 519
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1244
Mailing Address - Country:US
Mailing Address - Phone:786-606-9021
Mailing Address - Fax:
Practice Address - Street 1:850 NW 86TH AVE APT 519
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1244
Practice Address - Country:US
Practice Address - Phone:783-606-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT87722251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL882788500Medicaid