Provider Demographics
NPI:1972911196
Name:LUBBERS, ALI (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:LUBBERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 N BOGUS BASIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1024
Mailing Address - Country:US
Mailing Address - Phone:208-344-0737
Mailing Address - Fax:208-344-0759
Practice Address - Street 1:2302 N BOGUS BASIN RD STE C
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-1024
Practice Address - Country:US
Practice Address - Phone:208-344-0737
Practice Address - Fax:208-344-0759
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60611225100000X
IDPT-4827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist