Healthcare Provider Details

I. General information

NPI: 1104182849
Provider Name (Legal Business Name): KEVIN KUBINSKI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9337 KREWSTOWN RD
PHILADELPHIA PA
19115-3710
US

IV. Provider business mailing address

120 W GERMANTOWN PIKE SUITE 100
PLYMOUTH MEETING PA
19462-1420
US

V. Phone/Fax

Practice location:
  • Phone: 215-676-6760
  • Fax: 215-676-3746
Mailing address:
  • Phone: 610-270-0370
  • Fax: 610-270-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT021925
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: