MEDICARE: HUNTER N HUBERTY PT

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	11167	MN

General Provider Information

NPI Number	:	1104300524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNTER N HUBERTY PT

Provider Business Mailing Address
First Line	:	1939 MINNEHAHA AVE W STE 300
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1033
Country	:	US
Telephone Number	:	651-748-4338
Fax Number	:	651-748-2892

Provider Business Practice Location Address
First Line	:	146 LAKE ST N STE 200
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2555
Country	:	US
Telephone Number	:	651-275-4706
Fax Number	:	651-464-8547

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

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	09/26/2023

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Directions to “ HUNTER N HUBERTY PT” Practice Location

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