Provider Demographics
NPI:1386868701
Name:KUBINSKI, ERYN (PT)
Entity type:Individual
Prefix:
First Name:ERYN
Middle Name:
Last Name:KUBINSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERYN
Other - Middle Name:
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:115 REPUBLIC AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6570
Mailing Address - Country:US
Mailing Address - Phone:815-207-7463
Mailing Address - Fax:
Practice Address - Street 1:115 REPUBLIC AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6570
Practice Address - Country:US
Practice Address - Phone:815-207-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0189122251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.018912OtherPT LICENSE