Provider Demographics
NPI:1174703235
Name:KUBIK, REJAUNNE M (PT)
Entity type:Individual
Prefix:
First Name:REJAUNNE
Middle Name:M
Last Name:KUBIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REJAUNNE
Other - Middle Name:M
Other - Last Name:EISENMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2763 MANITOWOC RD
Mailing Address - Street 2:STE B
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6633
Mailing Address - Country:US
Mailing Address - Phone:920-468-8288
Mailing Address - Fax:920-468-9887
Practice Address - Street 1:2763 MANITOWOC RD
Practice Address - Street 2:STE B
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6633
Practice Address - Country:US
Practice Address - Phone:920-468-8288
Practice Address - Fax:920-468-9887
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4885-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4885-24OtherLICENSE NUMBER