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General NPI Number Information
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NPI Number | 1134618515
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Entity Type | Individual
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Provider Name | SETH HUBBARD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 427 E WASHINGTON ST
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City | SAINT LOUIS
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State | MI
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Zip | 48880-1980
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Country | US
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Telephone | 989-763-3904
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Fax |
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Provider Business Mailing Address
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Address Line | 9653 MONROE RD
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City | ELWELL
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State | MI
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Zip | 48832-9709
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Country | US
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Telephone |
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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 | 5501018066
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License Number State |
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