Provider Demographics
NPI:1285734111
Name:LUBIN, GRETCHEN SANGER (PT)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:SANGER
Last Name:LUBIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8028 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4814
Mailing Address - Country:US
Mailing Address - Phone:206-524-0124
Mailing Address - Fax:206-524-0125
Practice Address - Street 1:8028 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4814
Practice Address - Country:US
Practice Address - Phone:206-524-0124
Practice Address - Fax:206-524-0125
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00027982251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8431884Medicaid
WA0012457OtherL AND T
R12010Medicare UPIN
G8801219Medicare ID - Type Unspecified