Provider Demographics
NPI:1710686191
Name:LUBERSKI, EDWARD T JR (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:LUBERSKI
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 CHEQUERS CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8903
Mailing Address - Country:US
Mailing Address - Phone:443-910-1569
Mailing Address - Fax:
Practice Address - Street 1:2205 CHEQUERS CT
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8903
Practice Address - Country:US
Practice Address - Phone:443-910-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist