Healthcare Provider Details

I. General information

NPI: 1063117869
Provider Name (Legal Business Name): CHANTEL HUBBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9060 KIMBERLY BLVD STE 44
BOCA RATON FL
33434-2842
US

IV. Provider business mailing address

3685 NW 29TH ST
LAUDERDALE LAKES FL
33311-1846
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-7474
  • Fax:
Mailing address:
  • Phone: 954-540-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: