Healthcare Provider Details

I. General information

NPI: 1730784513
Provider Name (Legal Business Name): EMMA JOHANA HUBBELL LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 N HOLLYWOOD ST
MEMPHIS TN
38112-2522
US

IV. Provider business mailing address

1382 MOUNT MORIAH RD
MEMPHIS TN
38117-6620
US

V. Phone/Fax

Practice location:
  • Phone: 925-786-5423
  • Fax:
Mailing address:
  • Phone: 925-786-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: