Provider Demographics
NPI:1023899739
Name:HARBOR HOME THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:HARBOR HOME THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUBIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-721-9662
Mailing Address - Street 1:708 135TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-7638
Mailing Address - Country:US
Mailing Address - Phone:402-721-9662
Mailing Address - Fax:
Practice Address - Street 1:708 135TH ST NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-7638
Practice Address - Country:US
Practice Address - Phone:402-721-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty