Provider Demographics
NPI:1811101504
Name:HUBBARD-PARHAM, PATRICIA T (PT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:T
Last Name:HUBBARD-PARHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:T
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4931 EMPIRE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1620
Mailing Address - Country:US
Mailing Address - Phone:804-748-7974
Mailing Address - Fax:804-748-7974
Practice Address - Street 1:4931 EMPIRE PKWY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1620
Practice Address - Country:US
Practice Address - Phone:804-748-7974
Practice Address - Fax:804-748-7974
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305000109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
077260OtherANTHEM