Provider Demographics
NPI:1114392610
Name:HUBBARD, JASON KYLE (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:KYLE
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 1:3335 RICHLAND DR
Mailing Address - Street 2:APT 10
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3259
Mailing Address - Country:US
Mailing Address - Phone:626-241-7612
Mailing Address - Fax:
Practice Address - Street 1:319 ANACAPA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2351
Practice Address - Country:US
Practice Address - Phone:805-898-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist