Provider Demographics
NPI:1639062375
Name:DUB, ELIZABETH RAE (LAT, ATC, PT, DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RAE
Last Name:DUB
Suffix:
Gender:F
Credentials:LAT, ATC, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 N 51ST ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2664
Mailing Address - Country:US
Mailing Address - Phone:218-791-9013
Mailing Address - Fax:
Practice Address - Street 1:1811 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6337
Practice Address - Country:US
Practice Address - Phone:701-757-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND912-212255A2300X
ND2826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer