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General NPI Number Information
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NPI Number | 1124214416
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Entity Type | Individual
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Provider Name | LEANNE CAROL HUBER MPT
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Gender | Female
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 2900 CHARLEVOIX DR SE SUITE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7085
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Country | US
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Telephone | 616-575-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 6165 BLUE LAKE DR
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City | CINCINNATI
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State | OH
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Zip | 45247-7805
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Country | US
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Telephone | 513-289-5859
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 009830
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5301
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 33436
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5191
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License Number State | SC
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