Trey J Kubizna, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501012424 Issued in MI

Practice address

3035 Hoag Ave NE
Grand Rapids, MI 49525-9632

Phone

(616) 262-7263

Fax

(616) 365-9394

NPI assigned

Jan 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Functional Innovative Therapy, LLC

  • Physical Therapy Clinic/Center
  • Grand Rapids, MI
  • NPI 1093727802

  Physical Therapist

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1265411565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 HOAG AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259632",
            "telephone_number": "616-262-7263",
            "fax_number": "616-365-9394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 HOAG AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259632",
            "telephone_number": "616-262-7263",
            "fax_number": "616-365-9394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBIZNA",
        "first_name": "TREY",
        "middle_name": "J",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "6946",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501012424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "650D116680",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordyn Lynn Krzywos
• Lawrence Chunhao Ku, M.D.
• Andrea Marie Kuban, LLMSW
• Amanda Kubiak
• Kalin Kubiak, PA
• Brett David Kucej, M.D.
• Erin Kucharek, A-GNP-C
• Zachary Kucharek
• Sara Portwood Kuckhoff, DMD
• Lindsay Kuczera, LMSW

• Physical Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.