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General NPI Number Information
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NPI Number | 1720172638
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Entity Type | Individual
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Provider Name | MICHAEL HUBBARD PTA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 376 MANCHESTER SQUARE
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City | MANCHESTER
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State | KY
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Zip | 40962-9998
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Country | US
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Telephone | 606-598-7673
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Fax | 606-598-7948
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Provider Business Mailing Address
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Address Line | PO BOX 194
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City | GIRDLER
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State | KY
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Zip | 40943
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Country | US
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Telephone | 606-546-5215
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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 | A01771
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License Number State | KY
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