Provider Demographics
NPI:1659135028
Name:KUBIAK, SARAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KUBIAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1903
Mailing Address - Country:US
Mailing Address - Phone:517-783-6670
Mailing Address - Fax:517-990-6212
Practice Address - Street 1:214 N WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1903
Practice Address - Country:US
Practice Address - Phone:517-783-6670
Practice Address - Fax:517-990-6212
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist