Provider Demographics
NPI:1174578264
Name:KUBRYNSKI, JENNIFER BROOKS (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BROOKS
Last Name:KUBRYNSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 CAMBRIDGE COMMONS
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5854
Mailing Address - Country:US
Mailing Address - Phone:401-374-4523
Mailing Address - Fax:
Practice Address - Street 1:410 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4777
Practice Address - Country:US
Practice Address - Phone:860-638-3820
Practice Address - Fax:860-638-3840
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010049225100000X
CT8236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist