Individual
MR. STEPHEN LUBBEHUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC,LAT
Contact information
Practice address
10807 SMOKEY RIDGE PL, FORT WAYNE, IN 46818-8876
(260) 490-9957
Mailing address
10807 SMOKEY RIDGE PL, FORT WAYNE, IN 46818-8876
(260) 490-9957
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000286A
IN
Other
Enumeration date
11/05/2013
Last updated
11/05/2013
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