=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043121478
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DYLAN HUBER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2026
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1630 BEAVERCREEK RD STE A
-----------------------------------------------------
City | OREGON CITY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97045-4156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-607-0047
-----------------------------------------------------
Fax | 503-607-0051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 LYNDON FARM CT STE 300
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40223-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 726-202-3039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 66223
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------