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NPI Code Detail

MEDICARE: MR. ADAM ROY LUBBERS M.P.T.

MEDICARE: MR. ADAM ROY LUBBERS M.P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist7549MN

General Provider Information

NPI Number : 1598724916
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ADAM ROY LUBBERS M.P.T.
Provider Business Mailing Address
First Line : 3700 W SAINT GERMAIN ST
Second Line : APARTMENT 303
City : SAINT CLOUD
State : MN
Zip : 56301-7310
Country : US
Telephone Number : 320-491-8587
Fax Number :
Provider Business Practice Location Address
First Line : 402 RED RIVER AVE N
Second Line :
City : COLD SPRING
State : MN
Zip : 56320-1521
Country : US
Telephone Number : 320-685-7269
Fax Number : 320-685-7975
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 07/08/2007

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