Healthcare Provider Details

I. General information

NPI: 1578928248
Provider Name (Legal Business Name): EMILY LUBAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY HEASLEY

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SPORTSMAN DR STE 10
CLARION PA
16214-8572
US

IV. Provider business mailing address

7243 ROUTE 861
NEW BETHLEHEM PA
16242-2613
US

V. Phone/Fax

Practice location:
  • Phone: 814-221-9741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005438
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: