Provider Demographics
NPI:1962605527
Name:HUBBARD, DAVID MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 E PINE NEEDLE LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46160-9010
Mailing Address - Country:US
Mailing Address - Phone:317-403-6350
Mailing Address - Fax:
Practice Address - Street 1:4701 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1554
Practice Address - Country:US
Practice Address - Phone:317-722-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004100A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist