Healthcare Provider Details

I. General information

NPI: 1972720340
Provider Name (Legal Business Name): ELIZABETH J KUBA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13015 SUMMERFIELD SQUARE DR
RIVERVIEW FL
33578-7402
US

IV. Provider business mailing address

1127 NIKKI VIEW DR
BRANDON FL
33511-4879
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-8045
  • Fax: 855-388-5356
Mailing address:
  • Phone: 813-571-7184
  • Fax: 813-654-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT20880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: