Healthcare Provider Details

I. General information

NPI: 1386944148
Provider Name (Legal Business Name): CYNTHIA HUBERT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 UPPER CREEK DR
RUSKIN FL
33573-6814
US

IV. Provider business mailing address

8455 S SUNCOAST BLVD
HOMOSASSA FL
34446-5066
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-6797
  • Fax: 813-634-6794
Mailing address:
  • Phone: 352-382-7214
  • Fax: 352-382-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA21725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: