Healthcare Provider Details

I. General information

NPI: 1124516232
Provider Name (Legal Business Name): CARI ANN ZUBKE LAT, ATC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 09/29/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E UNIVERSITY AVE
GEORGETOWN TX
78626-6100
US

IV. Provider business mailing address

1114 BLUEGRASS CIR APT 4
CEDAR FALLS IA
50613-8165
US

V. Phone/Fax

Practice location:
  • Phone: 512-860-1382
  • Fax:
Mailing address:
  • Phone: 316-204-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT5130
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number105404
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: