Provider Demographics
NPI:1740383751
Name:KUBACAK, RAYMOND JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:KUBACAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:SMOKEY
Other - Middle Name:
Other - Last Name:KUBACAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-373-7116
Practice Address - Street 1:3267 BEE CAVES RD STE 126
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6774
Practice Address - Country:US
Practice Address - Phone:512-202-8634
Practice Address - Fax:512-961-8907
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1016228225100000X
TX1016228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T5480OtherBCBS
TX8L3706Medicare PIN
TX8T5480OtherBCBS