Healthcare Provider Details

I. General information

NPI: 1396199204
Provider Name (Legal Business Name): DEBRA HUBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 04/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E SOUTHERN AVE STE 310
TEMPE AZ
85282-5695
US

IV. Provider business mailing address

1400 E SOUTHERN AVE STE 310
TEMPE AZ
85282-5695
US

V. Phone/Fax

Practice location:
  • Phone: 866-308-2700
  • Fax: 888-438-0350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5750A
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: