Ma Irisa Hibanada Kubala, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05003464A Issued in IN

Practice address

7823 Old State Road 60
Sellersburg, IN 47172-1858

Phone

(812) 246-4272

Fax

(812) 246-8136

NPI assigned

Jul 11, 2008

Last updated

Jul 11, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215734400000",
    "number": "1396909198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4903 CREEKPOINTE TERRACE",
            "address_2": "APT 7",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402195908",
            "telephone_number": "502-968-7867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7823 OLD STATE ROAD 60",
            "city": "SELLERSBURG",
            "state": "IN",
            "postal_code": "471721858",
            "telephone_number": "812-246-4272",
            "fax_number": "812-246-8136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBALA",
        "first_name": "MA IRISA",
        "middle_name": "HIBANADA",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2008-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05003464A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Sellersburg, IN
• Providers in Sellersburg, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.