Provider Demographics
NPI:1629071394
Name:ADVANCED PHYSICAL THERAPY & BALANCE REHABILITATION LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY & BALANCE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUBIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-627-7012
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:STE B7011
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1807
Mailing Address - Country:US
Mailing Address - Phone:253-627-7012
Mailing Address - Fax:253-627-7014
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:STE B7011
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1807
Practice Address - Country:US
Practice Address - Phone:253-627-7012
Practice Address - Fax:253-627-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7123797Medicaid
WA7123797Medicaid