Healthcare Provider Details

I. General information

NPI: 1528824000
Provider Name (Legal Business Name): OWEN DAVID KUBALAK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 N HAMILTON RD STE 1F
WESTERVILLE OH
43081-2062
US

IV. Provider business mailing address

6100 N HAMILTON RD STE 1F
WESTERVILLE OH
43081-2062
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-0722
  • Fax:
Mailing address:
  • Phone: 614-366-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: