Healthcare Provider Details

I. General information

NPI: 1679496988
Provider Name (Legal Business Name): DORY HUBER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 MAPLE GROVE DR
MADISON WI
53719-5013
US

IV. Provider business mailing address

9529 W GIBBS LAKE RD
EDGERTON WI
53534-8847
US

V. Phone/Fax

Practice location:
  • Phone: 608-854-0592
  • Fax:
Mailing address:
  • Phone: 540-319-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4302-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: