MEDICARE: JESSICA HUBLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21590	OTHER	FL	LICENSE#

General Provider Information

NPI Number	:	1497863633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HUBLER

Provider Business Mailing Address
First Line	:	1702 COPPERSMITH CT
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33559-3389
Country	:	US
Telephone Number	:	570-617-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 E FLETCHER AVE STE 110
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4789
Country	:	US
Telephone Number	:	813-971-9351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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