Healthcare Provider Details

I. General information

NPI: 1700914850
Provider Name (Legal Business Name): POLLY ELAINE KUBIK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: POLLY ELAINE ANDERSON PT

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 S 59 ST #26 CROSSROADS PHYSICAL THERAPY
LINCOLN NE
68516
US

IV. Provider business mailing address

5550 S 59 #26 CROSSROADS PHYSICAL THERAPY
LINCOLN NE
68516
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-0800
  • Fax: 402-420-0801
Mailing address:
  • Phone: 402-420-0800
  • Fax: 402-420-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1568
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: