Provider Demographics
NPI:1215635172
Name:UBAYUBAY, KEITEL
Entity type:Individual
Prefix:
First Name:KEITEL
Middle Name:
Last Name:UBAYUBAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 STIRLING LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-4827
Mailing Address - Country:US
Mailing Address - Phone:331-233-8777
Mailing Address - Fax:
Practice Address - Street 1:3 EXECUTIVE CT STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9537
Practice Address - Country:US
Practice Address - Phone:847-387-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050082-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist