Provider Demographics
NPI:1154101905
Name:WRUBLEVSKI, KATHRYN LOUISE (LMT)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LOUISE
Last Name:WRUBLEVSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FAWN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1077
Mailing Address - Country:US
Mailing Address - Phone:518-637-4174
Mailing Address - Fax:
Practice Address - Street 1:2733 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-3317
Practice Address - Country:US
Practice Address - Phone:518-523-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist