Provider Demographics
NPI:1609144534
Name:SCHUBERT, DENISE MARIE (DPT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:SCHUBERT
Other - Last Name:IMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 PARKMAN ST
Mailing Address - Street 2:WACC 136
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3117
Mailing Address - Country:US
Mailing Address - Phone:617-724-0125
Mailing Address - Fax:617-726-2957
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WACC 136
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-0125
Practice Address - Fax:617-726-2957
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist