Provider Demographics
NPI:1639784002
Name:DUBNER, TERRY ANN (MT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:DUBNER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2502
Mailing Address - Country:US
Mailing Address - Phone:970-740-2673
Mailing Address - Fax:
Practice Address - Street 1:85 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2502
Practice Address - Country:US
Practice Address - Phone:970-749-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01140900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist