MEDICARE: ALICIA ELIZABETH HUBBARD MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT8108	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT8108	OTHER	GA	STATE

General Provider Information

NPI Number	:	1023282928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA ELIZABETH HUBBARD MPT

Provider Business Mailing Address
First Line	:	1303 STARK AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2038
Country	:	US
Telephone Number	:	706-221-6461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 STARK AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2038
Country	:	US
Telephone Number	:	706-221-6461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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