Provider Demographics
NPI:1801639075
Name:LAURA T. KUBLY, LMT, INC.
Entity type:Organization
Organization Name:LAURA T. KUBLY, LMT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:608-332-4330
Mailing Address - Street 1:7622 SE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3620
Mailing Address - Country:US
Mailing Address - Phone:608-332-4330
Mailing Address - Fax:503-498-5339
Practice Address - Street 1:1318 NW 20TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1671
Practice Address - Country:US
Practice Address - Phone:608-332-4330
Practice Address - Fax:503-498-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty