Provider Demographics
NPI:1922239060
Name:LUBACH, REYNA (DPT)
Entity type:Individual
Prefix:DR
First Name:REYNA
Middle Name:
Last Name:LUBACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:REYNA
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:604 MAIN ST
Mailing Address - Street 2:STE J
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1982
Mailing Address - Country:US
Mailing Address - Phone:650-440-4717
Mailing Address - Fax:650-440-4736
Practice Address - Street 1:604 MAIN ST
Practice Address - Street 2:STE J
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1982
Practice Address - Country:US
Practice Address - Phone:650-440-4717
Practice Address - Fax:650-440-4736
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT35204OtherPHYSICAL THERAPY LICENSE NUMBER