Provider Demographics
NPI:1336172311
Name:RUBMAN, ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:RUBMAN
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 1:1205 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408
Mailing Address - Country:US
Mailing Address - Phone:802-383-0400
Mailing Address - Fax:802-383-0420
Practice Address - Street 1:1205 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408
Practice Address - Country:US
Practice Address - Phone:802-383-0400
Practice Address - Fax:802-383-0420
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT39878OtherBLUE CROSS/BLUE SHIELD
VT1006860Medicaid
VT39878OtherBLUE CROSS/BLUE SHIELD