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General NPI Number Information
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NPI Number | 1225428873
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Entity Type | Individual
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Provider Name | JILLIAN HUBBEL L-AT, CMT
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 3330 N MINGO RD
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City | TULSA
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State | OK
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Zip | 74116-1211
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Country | US
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Telephone | 918-832-2404
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Fax | 918-832-2406
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Provider Business Mailing Address
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Address Line | 232 S 164TH EAST PL
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City | TULSA
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State | OK
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Zip | 74108-3306
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Country | US
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Telephone | 209-648-2704
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000021465
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 20318
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1205
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License Number State | OK
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