Healthcare Provider Details

I. General information

NPI: 1144518895
Provider Name (Legal Business Name): LISA MARY HUBER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 FOX RUN PKWY STE 100
YANKTON SD
57078-5370
US

IV. Provider business mailing address

2525 FOX RUN PKWY STE 100
YANKTON SD
57078-5370
US

V. Phone/Fax

Practice location:
  • Phone: 605-260-0918
  • Fax: 605-260-0912
Mailing address:
  • Phone: 605-660-9862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number0236
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number0236
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0236
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number0236
License Number StateSD
# 5
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0236
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: