Healthcare Provider Details

I. General information

NPI: 1962307272
Provider Name (Legal Business Name): SHELBY HUBBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 2ND AVE SW
MIAMI OK
74354-6743
US

IV. Provider business mailing address

310 2ND AVE SW
MIAMI OK
74354-6743
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-7736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7142
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: