Provider Demographics
NPI:1245477009
Name:LUBI, ERIC PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:ERIC PAUL
Middle Name:
Last Name:LUBI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 DUCKEYS RUN RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6109
Mailing Address - Country:US
Mailing Address - Phone:443-735-7775
Mailing Address - Fax:410-720-2151
Practice Address - Street 1:13946 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5000
Practice Address - Country:US
Practice Address - Phone:301-498-2212
Practice Address - Fax:301-498-2213
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60076268225100000X
MA18509225100000X
MD22777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22777OtherPT LICENSE