Provider Demographics
NPI:1003571100
Name:HUBER, PHILLIP (PTA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:HUBER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S STATE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6932
Mailing Address - Country:US
Mailing Address - Phone:302-734-0100
Mailing Address - Fax:302-734-0100
Practice Address - Street 1:1255 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6932
Practice Address - Country:US
Practice Address - Phone:302-734-0100
Practice Address - Fax:302-734-0101
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0011478225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant