Provider Demographics
NPI:1942639406
Name:LUBBEHUSEN, STEPHEN (ATC,LAT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:LUBBEHUSEN
Suffix:
Gender:M
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10807 SMOKEY RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-8876
Mailing Address - Country:US
Mailing Address - Phone:260-490-9957
Mailing Address - Fax:
Practice Address - Street 1:10807 SMOKEY RIDGE PL
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-8876
Practice Address - Country:US
Practice Address - Phone:260-490-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000286A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer