Active NPI
Brietta Lise Kubak, DPT
- Physical Therapist
- Portland, OR
National Provider Identifier
1083015804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 60791
- Practice address
- 1630 SW Morrison St
Portland, OR 97205-1916 - Phone
- (503) 227-7774
- Fax
- (503) 227-7548
- NPI assigned
- Sep 11, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 60791 | OR | Primary |
Addresses
Primary practice location
1630 SW Morrison St
Portland, OR 97205-1916
Mailing address
1630 SW Morrison St
Portland, OR 97205-1916
Phone (503) 227-7774
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60791 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519084800000",
"number": "1083015804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1630 SW MORRISON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051916",
"telephone_number": "503-227-7774",
"fax_number": "503-227-7548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1630 SW MORRISON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051916",
"telephone_number": "503-227-7774",
"fax_number": "503-227-7548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUBAK",
"first_name": "BRIETTA",
"middle_name": "LISE",
"name_prefix": "Ms.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-11",
"last_updated": "2018-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "OR",
"license": "60791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.