Provider Demographics
NPI:1205642931
Name:LUBBS, BRIAN EDWARD (CMT, RMT, CYT, BS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EDWARD
Last Name:LUBBS
Suffix:
Gender:M
Credentials:CMT, RMT, CYT, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 POWELL ST APT 33
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-3009
Mailing Address - Country:US
Mailing Address - Phone:628-204-9278
Mailing Address - Fax:
Practice Address - Street 1:625 POWELL ST APT 33
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-3009
Practice Address - Country:US
Practice Address - Phone:628-204-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist