Provider Demographics
NPI:1831637719
Name:ZUBOK, KATHLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ZUBOK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:BOWERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:5670 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3219
Practice Address - Country:US
Practice Address - Phone:313-633-9586
Practice Address - Fax:313-633-9589
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist