Provider Demographics
NPI:1700914850
Name:KUBIK, POLLY ELAINE (PT)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:ELAINE
Last Name:KUBIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:POLLY
Other - Middle Name:ELAINE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5550 S 59
Mailing Address - Street 2:#26 CROSSROADS PHYSICAL THERAPY
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-420-0800
Mailing Address - Fax:402-420-0801
Practice Address - Street 1:5550 S 59 ST
Practice Address - Street 2:#26 CROSSROADS PHYSICAL THERAPY
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-420-0800
Practice Address - Fax:402-420-0801
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist