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General NPI Number Information
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NPI Number | 1437346830
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Entity Type | Individual
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Provider Name | SHAWN TIFFIN HUBBARD MPT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2007
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 10660 OLD SAINT AUGUSTINE RD STE PT
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City | JACKSONVILLE
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State | FL
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Zip | 32257-1076
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Country | US
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Telephone | 904-619-5831
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Fax | 866-225-4350
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Provider Business Mailing Address
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Address Line | PO BOX 1975
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City | ROME
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State | GA
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Zip | 30162-1975
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Country | US
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Telephone | 904-619-5831
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Fax | 866-225-4350
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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 | PT21049
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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