Provider Demographics
NPI:1700259124
Name:KUBRICK, CLAYTON THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:THOMAS
Last Name:KUBRICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2757 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3138
Mailing Address - Country:US
Mailing Address - Phone:724-337-6522
Mailing Address - Fax:724-337-0630
Practice Address - Street 1:3160 KIPP AVE
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3546
Practice Address - Country:US
Practice Address - Phone:724-335-5526
Practice Address - Fax:724-335-6407
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist