Healthcare Provider Details

I. General information

NPI: 1679206205
Provider Name (Legal Business Name): DREW STUBER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 KROGER WAY
VERSAILLES KY
40383-1915
US

IV. Provider business mailing address

374 KROGER WAY
VERSAILLES KY
40383-1915
US

V. Phone/Fax

Practice location:
  • Phone: 859-286-6848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009177
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: