Provider Demographics
NPI:1598724916
Name:LUBBERS, ADAM ROY (MPT)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ROY
Last Name:LUBBERS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W SAINT GERMAIN ST
Mailing Address - Street 2:APARTMENT 303
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-7310
Mailing Address - Country:US
Mailing Address - Phone:320-491-8587
Mailing Address - Fax:
Practice Address - Street 1:402 RED RIVER AVE N
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-1521
Practice Address - Country:US
Practice Address - Phone:320-685-7269
Practice Address - Fax:320-685-7975
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist