Provider Demographics
NPI:1356907588
Name:RUBIO, STEPHEN ANTHONY
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:RUBIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 SATSUMA DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2177
Mailing Address - Country:US
Mailing Address - Phone:361-676-0541
Mailing Address - Fax:
Practice Address - Street 1:382 SATSUMA DR
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2177
Practice Address - Country:US
Practice Address - Phone:361-676-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2094609225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22520000XMedicaid