Individual
SHANAE AUDRYONNA KUBIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3904 BOULTON CT, PLANO, TX 75025-2050
(316) 209-0765
Mailing address
3904 BOULTON CT, PLANO, TX 75025-2050
(316) 209-0765
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000040789
ATHLETIC TRAINING CERTIFICATION NUMBER
—
Enumeration date
03/16/2021
Last updated
03/16/2021
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