Provider Demographics
NPI:1962788653
Name:LUBECK, ANDREA (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LUBECK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-752-2673
Mailing Address - Fax:360-752-0271
Practice Address - Street 1:1514 12TH STREET
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-752-2673
Practice Address - Fax:360-752-0271
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60205685225100000X
AKPHYP2217225100000X
OROR 60066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1962788653Medicaid
ORR178549Medicare PIN