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NPI Code Detail

MEDICARE: MR. MICHAEL HUBBARD PTA

MEDICARE: MR. MICHAEL HUBBARD PTA
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
1225100000XPhysical TherapistA01771KY

General Provider Information

NPI Number : 1720172638
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL HUBBARD PTA
Provider Business Mailing Address
First Line : PO BOX 194
Second Line :
City : GIRDLER
State : KY
Zip : 40943
Country : US
Telephone Number : 606-546-5215
Fax Number :
Provider Business Practice Location Address
First Line : 376 MANCHESTER SQUARE
Second Line :
City : MANCHESTER
State : KY
Zip : 40962-9998
Country : US
Telephone Number : 606-598-7673
Fax Number : 606-598-7948
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/08/2007

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