Provider Demographics
NPI:1659607133
Name:RUBBO, THEODORE R
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:R
Last Name:RUBBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 N WICKHAM RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6616
Mailing Address - Country:US
Mailing Address - Phone:321-259-1029
Mailing Address - Fax:321-259-1037
Practice Address - Street 1:5000 CHESHIRE PKWY N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4103
Practice Address - Country:US
Practice Address - Phone:763-268-4084
Practice Address - Fax:763-268-4240
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4457237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist