Provider Demographics
NPI:1427143031
Name:HUBBARD, NORMAN (RPT)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130
Mailing Address - Country:US
Mailing Address - Phone:530-257-8989
Mailing Address - Fax:530-257-4649
Practice Address - Street 1:711 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130
Practice Address - Country:US
Practice Address - Phone:530-257-8989
Practice Address - Fax:530-257-4649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 12628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ41322ZOtherBLUE SHIELD OF CALIFORNIA
CA00PT126280OtherBLUE CROSS OF CALIFORNIA
CA610626400OtherO.W.C.P. / US DEPT OF LAB
CA680442103OtherTAX ID
CA00PT126280OtherBLUE CROSS OF CALIFORNIA