Provider Demographics
NPI:1649792870
Name:CUBILLOS, LAURA STEPHANIE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:STEPHANIE
Last Name:CUBILLOS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E HALLANDALE BEACH BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4641
Mailing Address - Country:US
Mailing Address - Phone:954-456-6080
Mailing Address - Fax:
Practice Address - Street 1:1250 E HALLANDALE BEACH BLVD STE 700
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4641
Practice Address - Country:US
Practice Address - Phone:954-456-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer