Healthcare Provider Details

I. General information

NPI: 1437343043
Provider Name (Legal Business Name): LINDA MARIE CUBAKOVIC PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 COUNTRY CLUB RD
MONONGAHELA PA
15063-1057
US

IV. Provider business mailing address

1938 DIANE MERLE DR
N HUNTINGDON PA
15642-5202
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-2062
  • Fax:
Mailing address:
  • Phone: 724-864-5326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberTE003080L
License Number StateWV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: