Provider Demographics
NPI:1902376338
Name:RUBAKHINA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RUBAKHINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 TRAPELO RD # 2
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1417
Mailing Address - Country:US
Mailing Address - Phone:978-500-3003
Mailing Address - Fax:
Practice Address - Street 1:431 TRAPELO RD # 2
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1417
Practice Address - Country:US
Practice Address - Phone:978-500-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist