Provider Demographics
NPI:1881689412
Name:KUBATKO, MARTHA RAFETTO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:RAFETTO
Last Name:KUBATKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-1946
Mailing Address - Country:US
Mailing Address - Phone:724-548-7540
Mailing Address - Fax:724-548-7540
Practice Address - Street 1:191 BUTLER RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2261
Practice Address - Country:US
Practice Address - Phone:724-548-4438
Practice Address - Fax:724-548-4438
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000139E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA418832Medicare ID - Type UnspecifiedPHYSICAL THERAPY