Provider Demographics
NPI:1679015317
Name:KUBIT, MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KUBIT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PINEBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-2302
Mailing Address - Country:US
Mailing Address - Phone:866-221-5405
Mailing Address - Fax:
Practice Address - Street 1:1755 WITTINGTON PL
Practice Address - Street 2:SUITE 175
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-1927
Practice Address - Country:US
Practice Address - Phone:866-221-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist