Provider Demographics
NPI:1881679801
Name:KUBISTEK, MICHELLE C (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:KUBISTEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:C
Other - Last Name:GUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:295 HILL PLACE RD
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1249
Mailing Address - Country:US
Mailing Address - Phone:724-745-2856
Mailing Address - Fax:
Practice Address - Street 1:998B MAIN STREET
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314
Practice Address - Country:US
Practice Address - Phone:724-239-5777
Practice Address - Fax:724-239-3036
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist