Healthcare Provider Details

I. General information

NPI: 1477127116
Provider Name (Legal Business Name): MICHAEL GERALD LUBAHN DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 COUNTY HIGHWAY I
CHIPPEWA FALLS WI
54729-5414
US

IV. Provider business mailing address

2655 COUNTY HIGHWAY I
CHIPPEWA FALLS WI
54729-5414
US

V. Phone/Fax

Practice location:
  • Phone: 715-726-4200
  • Fax:
Mailing address:
  • Phone: 715-726-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12351
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15932
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: