Provider Demographics
NPI:1750995387
Name:UBERT, BRIAN (BCMT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:UBERT
Suffix:
Gender:M
Credentials:BCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3953
Mailing Address - Country:US
Mailing Address - Phone:913-706-7426
Mailing Address - Fax:
Practice Address - Street 1:401 ARKANSAS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1338
Practice Address - Country:US
Practice Address - Phone:913-706-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009021391225700000X
KSCL-28822225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty